Healthcare Provider Details

I. General information

NPI: 1407468580
Provider Name (Legal Business Name): INTRACARE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 SW 12TH AVE STE 101D
DEERFIELD BEACH FL
33442-3114
US

IV. Provider business mailing address

160 SW 12TH AVE STE 101D
DEERFIELD BEACH FL
33442-3114
US

V. Phone/Fax

Practice location:
  • Phone: 888-327-2233
  • Fax: 888-439-4453
Mailing address:
  • Phone: 888-327-2233
  • Fax: 888-439-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MILES GILMAN
Title or Position: DIRECTOR
Credential: PHARMD
Phone: 888-327-2233