Healthcare Provider Details

I. General information

NPI: 1265517536
Provider Name (Legal Business Name): NORTHWEST CENTER FOR INFERTILITY AND REPRODUCTIVE ENDOCRINOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 N STATE RD 7 SUITE 200
MARGATE FL
33063
US

IV. Provider business mailing address

3251 N STATE RD 7 SUITE 200
MARGATE FL
33063
US

V. Phone/Fax

Practice location:
  • Phone: 954-247-6200
  • Fax: 954-247-6262
Mailing address:
  • Phone: 954-247-6200
  • Fax: 954-247-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN RUNA
Title or Position: EXECUTIVE VICE PRESIDENT OF OPERAT
Credential:
Phone: 720-810-0707