Healthcare Provider Details

I. General information

NPI: 1851276968
Provider Name (Legal Business Name): FAMILY MEDICAL GROUP MARGATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6260 W ATLANTIC BLVD
MARGATE FL
33063-5129
US

IV. Provider business mailing address

12391 SW 130TH ST
MIAMI FL
33186-6208
US

V. Phone/Fax

Practice location:
  • Phone: 954-494-5530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ILEANA COLLADO
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 786-971-8016