Healthcare Provider Details

I. General information

NPI: 1093084014
Provider Name (Legal Business Name): PREVENTIVE MEDICINE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SW 198TH TER
SOUTHWEST RANCHES FL
33332-1135
US

IV. Provider business mailing address

4800 SW 198TH TER
SOUTHWEST RANCHES FL
33332-1135
US

V. Phone/Fax

Practice location:
  • Phone: 954-600-9047
  • Fax:
Mailing address:
  • Phone: 954-600-9047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CURTIS ERWIN WILKINSON
Title or Position: DR
Credential: DO
Phone: 954-600-9047