Healthcare Provider Details

I. General information

NPI: 1790915304
Provider Name (Legal Business Name): ALEISHA OLBY-CANIK DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N MILITARY TRL SUITE 245
BOCA RATON FL
33431-6365
US

IV. Provider business mailing address

200 SE 3RD ST
POMPANO BEACH FL
33060-7118
US

V. Phone/Fax

Practice location:
  • Phone: 561-994-2007
  • Fax: 561-994-2003
Mailing address:
  • Phone: 954-449-3763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEISHA A OLBY
Title or Position: OWNER
Credential: DO
Phone: 954-449-3763