Healthcare Provider Details

I. General information

NPI: 1275201972
Provider Name (Legal Business Name): CASA MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 SHERIDAN ST STE 301
HOLLYWOOD FL
33021-3433
US

IV. Provider business mailing address

4601 SHERIDAN ST STE 301
HOLLYWOOD FL
33021-3433
US

V. Phone/Fax

Practice location:
  • Phone: 786-556-8723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NARANBAATAR ERKHEMBAATAR
Title or Position: OWNER
Credential: ARNP
Phone: 786-556-8723