Healthcare Provider Details

I. General information

NPI: 1396840674
Provider Name (Legal Business Name): FLORIDA INSTITUTE OF HEALTH LTD LLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 W OAKLAND PARK BLVD SUITE A
LAUDERDALE LAKES FL
33313-7260
US

IV. Provider business mailing address

4850 W OAKLAND PARK BLVD SUITE 203
LAUDERDALE LAKES FL
33313-7260
US

V. Phone/Fax

Practice location:
  • Phone: 954-735-6330
  • Fax: 954-739-1924
Mailing address:
  • Phone: 954-484-7030
  • Fax: 954-484-1280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. AVA ZAKEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-484-7030