Healthcare Provider Details

I. General information

NPI: 1740896281
Provider Name (Legal Business Name): MERAKI MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12565 ORANGE DR STE 401
DAVIE FL
33330-4305
US

IV. Provider business mailing address

12565 ORANGE DR STE 401
DAVIE FL
33330-4305
US

V. Phone/Fax

Practice location:
  • Phone: 954-998-7574
  • Fax: 954-251-4846
Mailing address:
  • Phone: 954-998-7574
  • Fax: 954-251-4846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LYDIA ARVELO
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 954-998-7574