Healthcare Provider Details

I. General information

NPI: 1023422169
Provider Name (Legal Business Name): BAIJUMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11508 NW 73RD MANOR
PARKLAND FL
33076
US

IV. Provider business mailing address

11508 NW 73RD MANOR
PARKLAND FL
33076
US

V. Phone/Fax

Practice location:
  • Phone: 954-547-8481
  • Fax: 954-753-4837
Mailing address:
  • Phone: 954-547-8481
  • Fax: 954-753-4837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHOK PATEL
Title or Position: CHAIRMAN AND CEO
Credential: MD
Phone: 954-547-8481