MEDICARE: BROWARD PHYSICIANS GROUP OF FLORIDA, 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	261QP2300X	Primary Care Clinic/Center	ME32388	FL

General Provider Information

NPI Number	:	1437440237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWARD PHYSICIANS GROUP OF FLORIDA, LLC

Provider Business Mailing Address
First Line	:	2303 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6711
Country	:	US
Telephone Number	:	954-292-6217
Fax Number	:

Provider Business Practice Location Address
First Line	:	2303 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6711
Country	:	US
Telephone Number	:	954-292-6217
Fax Number	:

Authorized Official
Title or Position	:	MGRM
Name	:	DR. EMILIO E CASTANEDA
Credential	:	M.D.
Telephone Number	:	954-292-6217

Provider Enumeration Date	:	04/27/2011
Last Update Date	:	04/27/2011

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