MEDICARE: BROWARD MEDICAL SPECIALIST INC

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	ME 107125	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	:	1700195930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWARD MEDICAL SPECIALIST INC

Provider Business Mailing Address
First Line	:	2205 BAY DR
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-2912
Country	:	US
Telephone Number	:	754-888-5656
Fax Number	:	954-785-8333

Provider Business Practice Location Address
First Line	:	2205 BAY DR
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-2912
Country	:	US
Telephone Number	:	754-888-5656
Fax Number	:	954-785-8333

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIPRIANOS S ARMENAKIS
Credential	:	M.D.
Telephone Number	:	754-888-5656

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	08/24/2013

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