Healthcare Provider Details

I. General information

NPI: 1346761392
Provider Name (Legal Business Name): VANGUARD MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 DAVIE BLVD
FORT LAUDERDALE FL
33312-2758
US

IV. Provider business mailing address

603 N FLAMINGO RD STE 150
PEMBROKE PINES FL
33028-1022
US

V. Phone/Fax

Practice location:
  • Phone: 954-436-6660
  • Fax: 954-436-6655
Mailing address:
  • Phone: 954-436-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MIAN HASAN
Title or Position: MD
Credential: MD
Phone: 954-436-6660