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General NPI Number Information
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NPI Number | 1053775718
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Entity Type | Organization
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Legal Business Name | PERSONALIZED HEALTH AND PREVENTIVE MEDICINE LLC
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 04/08/2016
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Provider Practice Location Address
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Address Line | 20950 NE 27TH CT SUITE 305
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City | AVENTURA
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State | FL
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Zip | 33180-1232
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Country | US
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Telephone | 954-621-6094
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Fax |
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Provider Business Mailing Address
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Address Line | 1573 VICTORIA ISLE WAY
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City | WESTON
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State | FL
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Zip | 33327-1314
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Country | US
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Telephone | 954-621-6094
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HAMID FEIZ
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Credential | MD
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Telephone | 954-621-6094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME87946
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License Number State | FL
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