MEDICARE: BRAINTECH DIAGNOSTICS LLC

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	261Q00000X	Clinic/Center		FL
2	261QH0100X	Health Service Clinic/Center		FL

General Provider Information

NPI Number	:	1366962037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAINTECH DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	7385 NW 68TH AVE
Second Line	:
City	:	PARKLAND
State	:	FL
Zip	:	33067-3914
Country	:	US
Telephone Number	:	954-304-5483
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 E LAS OLAS BLVD STE 120
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33301-4261
Country	:	US
Telephone Number	:	954-304-5483
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALEX LUNDY
Credential	:
Telephone Number	:	954-304-5483

Provider Enumeration Date	:	06/23/2017
Last Update Date	:	06/23/2017

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Directions to “BRAINTECH DIAGNOSTICS LLC ” Practice Location

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