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General NPI Number Information
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NPI Number | 1740302983
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Entity Type | Organization
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Legal Business Name | HEALTHEXCEL MEDICAL GROUP AT PEMBROKE PINES
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 1150 N UNIVERSITY DR
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-5031
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Country | US
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Telephone | 954-432-7860
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Fax | 954-432-2109
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Provider Business Mailing Address
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Address Line | 1150 N UNIVERSITY DR
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-5031
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Country | US
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Telephone | 954-432-7860
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Fax | 954-432-2109
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD COLLADO
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Credential |
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Telephone | 305-207-1632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | OS3370
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License Number State | FL
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