=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083934723
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOCTOR HOUSE CALLS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2010
-----------------------------------------------------
Last Update Date | 06/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9858 CLINT MOORE RD SUITE C-111-236
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33496-1034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-676-7488
-----------------------------------------------------
Fax | 561-910-4785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9858 CLINT MOORE RD SUITE C-111-236
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33496-1034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-676-7488
-----------------------------------------------------
Fax | 561-910-4785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. SUZANNE PAVLOU
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 561-676-7488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME90011
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------