MEDICARE: COMPREHENSIVE HEALTH & WELLNESS CENTER, P.A.

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	261QP2300X	Primary Care Clinic/Center	ME89650	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184931339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE HEALTH & WELLNESS CENTER, P.A.

Provider Business Mailing Address
First Line	:	4040 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3536
Country	:	US
Telephone Number	:	954-322-7166
Fax Number	:	954-322-7169

Provider Business Practice Location Address
First Line	:	4040 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3536
Country	:	US
Telephone Number	:	954-322-7166
Fax Number	:	954-322-7169

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK DERRICK CHIN-LENN
Credential	:	M.D.
Telephone Number	:	954-322-7166

Provider Enumeration Date	:	09/09/2010
Last Update Date	:	08/25/2022

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