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General NPI Number Information
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NPI Number | 1790118180
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Entity Type | Organization
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Legal Business Name | EVERGREEN MEDICAL CENTER, PA
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 400 N HIATUS RD SUITE 206
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-5214
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Country | US
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Telephone | 954-380-8550
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Fax | 954-380-8580
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Provider Business Mailing Address
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Address Line | 5846 S FLAMINGO RD #280
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City | COOPER CITY
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State | FL
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Zip | 33330-3237
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Country | US
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Telephone | 954-380-8550
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Fax | 954-380-8580
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ALSU LEYKIND
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Credential | DNP APRN
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Telephone | 954-380-8550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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