MEDICARE: OFF WEIGHT LOSS SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1295503662	OTHER		CMS
2	1578511028	OTHER		CMS

General Provider Information

NPI Number	:	1275333189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OFF WEIGHT LOSS SOLUTIONS

Provider Business Mailing Address
First Line	:	4522 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4522 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5204
Country	:	US
Telephone Number	:	954-335-7633
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GEORGE YOUAKIM
Credential	:
Telephone Number	:	954-335-7633

Provider Enumeration Date	:	03/18/2025
Last Update Date	:	03/18/2025

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Directions to “OFF WEIGHT LOSS SOLUTIONS ” Practice Location

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