MEDICARE: BODYCARE LIPOSCULTURE AND ANTI-AGING CLINIC

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	207Q00000X	Family Medicine Physician	ME0074811	FL

General Provider Information

NPI Number	:	1881976819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODYCARE LIPOSCULTURE AND ANTI-AGING CLINIC

Provider Business Mailing Address
First Line	:	100 N FEDERAL HWY
Second Line	:	THE WAVERLY AT LAS OLAS
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1129
Country	:	US
Telephone Number	:	954-765-1316
Fax Number	:	954-765-1461

Provider Business Practice Location Address
First Line	:	100 N FEDERAL HWY
Second Line	:	THE WAVERLY AT LAS OLAS
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1129
Country	:	US
Telephone Number	:	954-765-1316
Fax Number	:	954-765-1461

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RODGER G STRATT
Credential	:	MD
Telephone Number	:	954-765-1316

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	09/15/2011

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