Healthcare Provider Details

I. General information

NPI: 1063671246
Provider Name (Legal Business Name): EMAD EKLADIOS M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 N UNIVERSITY DR SUITE C
PEMBROKE PINES FL
33024-3611
US

IV. Provider business mailing address

PO BOX 848488
PEMBROKE PINES FL
33084-0488
US

V. Phone/Fax

Practice location:
  • Phone: 954-963-2555
  • Fax: 954-963-2288
Mailing address:
  • Phone: 954-963-2555
  • Fax: 954-963-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME0064340
License Number StateFL

VIII. Authorized Official

Name: EMAD EZRA EKLADIOS
Title or Position: PRESIDENT
Credential: M D
Phone: 954-963-2555