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General NPI Number Information
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NPI Number | 1710739537
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Entity Type | Organization
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Legal Business Name | MEDM LLC
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Dates
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Enumeration Date | 04/04/2024
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 4513 NW 31ST AVE
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City | OAKLAND PARK
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State | FL
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Zip | 33309-3403
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Country | US
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Telephone | 954-824-2027
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Fax |
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Provider Business Mailing Address
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Address Line | 4513 NW 31ST AVE
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City | OAKLAND PARK
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State | FL
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Zip | 33309-3403
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Country | US
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Telephone | 954-824-2027
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MARK MATUS
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Credential | MD
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Telephone | 786-630-8993
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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 |
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License Number State |
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