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General NPI Number Information
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NPI Number | 1851276968
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL GROUP MARGATE LLC
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 6260 W ATLANTIC BLVD
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City | MARGATE
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State | FL
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Zip | 33063-5129
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Country | US
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Telephone | 954-494-5530
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Fax |
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Provider Business Mailing Address
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Address Line | 12391 SW 130TH ST
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City | MIAMI
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State | FL
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Zip | 33186-6208
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | ILEANA COLLADO
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Credential |
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Telephone | 786-971-8016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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