Healthcare Provider Details

I. General information

NPI: 1972930980
Provider Name (Legal Business Name): BROWARD INTENSIVIST GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9633 W BROWARD BLVD SUITE 6
PLANTATION FL
33324-2332
US

IV. Provider business mailing address

9633 W BROWARD BLVD SUITE 6
PLANTATION FL
33324-2332
US

V. Phone/Fax

Practice location:
  • Phone: 954-835-0005
  • Fax: 954-472-8271
Mailing address:
  • Phone: 954-835-0005
  • Fax: 954-472-8271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberOS5264
License Number StateFL

VIII. Authorized Official

Name: DR. MICHAEL A FLICKER
Title or Position: OWNER
Credential: DO
Phone: 954-835-0005