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General NPI Number Information
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NPI Number | 1447734322
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Entity Type | Organization
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Legal Business Name | BROWARD CENTER OF MEDICAL EXCELLENCE INC.
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 103 SE 20TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2846
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Country | US
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Telephone | 954-462-7558
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Fax | 954-525-5820
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Provider Business Mailing Address
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Address Line | 103 SE 20TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2846
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Country | US
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Telephone | 954-462-7558
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Fax | 954-525-5820
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KATHY DEDE
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Credential |
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Telephone | 954-851-3108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME13408
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License Number State | FL
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