Healthcare Provider Details

I. General information

NPI: 1295069409
Provider Name (Legal Business Name): BROWARD PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S FLAMINGO RD SUITE 358
PEMBROKE PINES FL
33027-1770
US

IV. Provider business mailing address

320 S FLAMINGO RD SUITE 358
PEMBROKE PINES FL
33027-1770
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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MIAN AHMED HASAN
Title or Position: MGR
Credential: MD
Phone: 954-436-6660