Healthcare Provider Details

I. General information

NPI: 1073141156
Provider Name (Legal Business Name): ASSOCIATESMD MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 N FLAMINGO RD
PEMBROKE PINES FL
33028-3500
US

IV. Provider business mailing address

4780 SW 64TH AVE STE 103
DAVIE FL
33314-4400
US

V. Phone/Fax

Practice location:
  • Phone: 954-450-8500
  • Fax: 954-450-8502
Mailing address:
  • Phone: 954-434-1705
  • Fax: 800-642-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUIS FELIPE LAFRATTA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 954-434-1705