Healthcare Provider Details

I. General information

NPI: 1467447888
Provider Name (Legal Business Name): EMAD E EKLADIOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date: 03/22/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

140A S FEDERAL HWY
DANIA BEACH FL
33004-3623
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-8100
  • Fax: 954-922-6898
Mailing address:
  • Phone: 954-276-5663
  • Fax: 954-276-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME64340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: