=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902043342
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT WARREN ENTERPRISES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2009
-----------------------------------------------------
Last Update Date | 01/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12014 MIRAMAR PKWY
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33025-7000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-438-6228
-----------------------------------------------------
Fax | 954-438-1596
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12014 MIRAMAR PKWY
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33025-7000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-438-6228
-----------------------------------------------------
Fax | 954-438-1596
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT W. FLEIGELMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 954-438-6228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | ME0025703
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------