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General NPI Number Information
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NPI Number | 1871959882
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Entity Type | Organization
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Legal Business Name | EM9699 LLC
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Dates
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Enumeration Date | 01/06/2016
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Last Update Date | 01/06/2016
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Provider Practice Location Address
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Address Line | 10480 NW 11TH CT
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City | PLANTATION
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State | FL
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Zip | 33322-6585
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Country | US
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Telephone | 954-868-2452
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Fax |
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Provider Business Mailing Address
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Address Line | 10480 NW 11TH CT
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City | PLANTATION
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State | FL
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Zip | 33322-6585
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Country | US
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Telephone | 954-868-2452
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LINDA DOLIN
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Credential | MD
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Telephone | 954-868-2452
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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 |
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License Number State |
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