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General NPI Number Information
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NPI Number | 1972824613
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Entity Type | Organization
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Legal Business Name | GENERAL MEDICINE AND URGENT CARE CLINIC
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Dates
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Enumeration Date | 06/16/2010
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 5913 S CONGRESS AVE
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City | ATLANTIS
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State | FL
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Zip | 33462-1303
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Country | US
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Telephone | 561-965-4300
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Fax | 561-965-4399
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Provider Business Mailing Address
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Address Line | 5913 S CONGRESS AVE
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City | ATLANTIS
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State | FL
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Zip | 33462-1303
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Country | US
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Telephone | 561-965-4300
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Fax | 561-965-4399
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. M. RAHAT FADERANI
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Credential | D,O,, M.P.H.
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Telephone | 561-965-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OS10474
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License Number State | FL
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