Healthcare Provider Details

I. General information

NPI: 1285636704
Provider Name (Legal Business Name): LIBERTY MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 N ANDREWS AVE STE 700
FORT LAUDERDALE FL
33309-2199
US

IV. Provider business mailing address

6700 N ANDREWS AVE STE 700
FORT LAUDERDALE FL
33309-2199
US

V. Phone/Fax

Practice location:
  • Phone: 772-398-5800
  • Fax:
Mailing address:
  • Phone: 772-398-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: EDWARD KUNZWEILER
Title or Position: VP
Credential:
Phone: 772-398-5870