=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447382742
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROCARE HEALTH CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2007
-----------------------------------------------------
Last Update Date | 11/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1380 NE MIAMI GARDENS DR SUITE 280
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33179-4707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-274-8080
-----------------------------------------------------
Fax | 786-274-8949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1380 NE MIAMI GARDENS DR SUITE 280
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33179-4707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-274-8080
-----------------------------------------------------
Fax | 786-274-8949
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. RONALD S. LUBETSKY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 786-274-8080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME0074933
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------