Healthcare Provider Details

I. General information

NPI: 1386925196
Provider Name (Legal Business Name): 4KUS CONSULTING GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 N HIATUS RD
SUNRISE FL
33351-7919
US

IV. Provider business mailing address

4800 N HIATUS RD
SUNRISE FL
33351-7919
US

V. Phone/Fax

Practice location:
  • Phone: 954-990-8082
  • Fax: 954-990-8084
Mailing address:
  • Phone: 954-990-8082
  • Fax: 954-990-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM C MCCORMICK JR.
Title or Position: CEO
Credential: MBA
Phone: 954-990-8082