Healthcare Provider Details

I. General information

NPI: 1649803883
Provider Name (Legal Business Name): USIFIYOKHO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E LAS OLAS BLVD STE 300
FORT LAUDERDALE FL
33301-2882
US

IV. Provider business mailing address

6471 SW 26TH CT
MIRAMAR FL
33023-3809
US

V. Phone/Fax

Practice location:
  • Phone: 954-740-3162
  • Fax:
Mailing address:
  • Phone: 954-740-3162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SIMEON USIFO OSEMOTA
Title or Position: OWNER/CEO
Credential: MD
Phone: 954-740-3162