MEDICARE: BROWARD MEDICAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1144464348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWARD MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	1226 SW 3RD AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33315-1507
Country	:	US
Telephone Number	:	954-527-0222
Fax Number	:	954-763-3544

Provider Business Practice Location Address
First Line	:	1226 SW 3RD AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33315-1507
Country	:	US
Telephone Number	:	954-257-0222
Fax Number	:	954-763-3544

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HUSMAN KHAN
Credential	:	M.D.
Telephone Number	:	954-527-0222

Provider Enumeration Date	:	05/01/2009
Last Update Date	:	05/01/2009

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