=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700195930
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROWARD MEDICAL SPECIALIST INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2010
-----------------------------------------------------
Last Update Date | 08/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2205 BAY DR
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-2912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-888-5656
-----------------------------------------------------
Fax | 954-785-8333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2205 BAY DR
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-2912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-888-5656
-----------------------------------------------------
Fax | 954-785-8333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KIPRIANOS S ARMENAKIS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 754-888-5656
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME 107125
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------