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General NPI Number Information
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NPI Number | 1790086023
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Entity Type | Organization
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Legal Business Name | INNOVATIVE CARE II, LLC
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 12600 PEMBROKE RD SUITE 100
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City | MIRAMAR
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State | FL
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Zip | 33027-2544
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Country | US
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Telephone | 954-843-7230
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Fax | 877-671-4101
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Provider Business Mailing Address
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Address Line | 1 SW 129TH AVE STE 304
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1717
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Country | US
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Telephone | 954-843-7230
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Fax | 877-671-4101
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | GOKHAN GUVENLI
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Credential | MD
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Telephone | 954-450-9595
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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 | OS10374
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License Number State | FL
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