Healthcare Provider Details

I. General information

NPI: 1174608699
Provider Name (Legal Business Name): VANGUARD MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 N FLAMINGO RD SUITE 150
PEMBROKE PINES FL
33028-1023
US

IV. Provider business mailing address

603 N FLAMINGO RD SUITE 150
PEMBROKE PINES FL
33028-1023
US

V. Phone/Fax

Practice location:
  • Phone: 954-436-6660
  • Fax: 954-436-6655
Mailing address:
  • Phone: 954-436-6660
  • Fax: 954-436-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME80305
License Number StateFL

VIII. Authorized Official

Name: ROBYN PAPPAS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 954-362-2691