Healthcare Provider Details

I. General information

NPI: 1720227523
Provider Name (Legal Business Name): KEJARO MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 N STATE ROAD 7 SUITE 201
MARGATE FL
33063-5737
US

IV. Provider business mailing address

PO BOX 4008
FORT LAUDERDALE FL
33338-4008
US

V. Phone/Fax

Practice location:
  • Phone: 954-972-4900
  • Fax: 954-917-4940
Mailing address:
  • Phone:
  • Fax: 954-564-7976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA83200
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME86367
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME86367
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA83200
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA83200
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME86367
License Number StateFL

VIII. Authorized Official

Name: DR. KEITH JAMAL ROBINSON
Title or Position: MANAGER
Credential: MD
Phone: 954-564-7976