Healthcare Provider Details

I. General information

NPI: 1083912778
Provider Name (Legal Business Name): K&A PHLEBOTOMY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 SW 71TH TERRACE
NORTH LAUDERDALE FL
33068-5584
US

IV. Provider business mailing address

190 NE 199 ST STE 201
NORTH MIAMI BEACH FL
33179
US

V. Phone/Fax

Practice location:
  • Phone: 954-369-7253
  • Fax:
Mailing address:
  • Phone: 786-269-2388
  • Fax: 786-565-9914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDRE T WHARTON
Title or Position: CEO
Credential:
Phone: 786-565-9370