=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558513408
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIA UNLIMITED INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2008
-----------------------------------------------------
Last Update Date | 03/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1777 S ANDREWS AVE SUITE 201
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33316-2517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-533-1104
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1777 S ANDREWS AVE SUITE 201
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33316-2517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-533-1104
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MALKAN PATEL
-----------------------------------------------------
Credential | D.O
-----------------------------------------------------
Telephone | 954-644-0284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------