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General NPI Number Information
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NPI Number | 1306094586
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Entity Type | Organization
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Legal Business Name | MEDI MD
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Dates
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Enumeration Date | 08/31/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7950 SW 30TH ST STE 200
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City | DAVIE
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State | FL
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Zip | 33328-1979
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Country | US
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Telephone | 888-674-0160
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Fax | 888-467-1802
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Provider Business Mailing Address
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Address Line | 7950 SW 30TH ST STE 200
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City | DAVIE
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State | FL
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Zip | 33328-1979
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Country | US
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Telephone | 888-674-0160
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Fax | 866-467-1802
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Authorized Official
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Title or Position | EXEC
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Name | SEBASTIAN AHMED
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Credential |
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Telephone | 888-674-0160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 602238
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 0601
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License Number State | FL
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