MEDICARE: PRESTIGE CLINICIANS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	261QU0200X	Urgent Care Clinic/Center
4	363LF0000X	Family Nurse Practitioner
5	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1497213755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE CLINICIANS LLC

Provider Business Mailing Address
First Line	:	4513 NW 31ST AVE STE 1
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-3403
Country	:	US
Telephone Number	:	954-496-2599
Fax Number	:	954-337-0236

Provider Business Practice Location Address
First Line	:	4513 NW 31ST AVE STE 1
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33309-3403
Country	:	US
Telephone Number	:	954-496-2599
Fax Number	:	954-337-0236

Authorized Official
Title or Position	:	FNP
Name	:	MR. HENRY ODAZIE
Credential	:
Telephone Number	:	954-496-2599

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	03/20/2024

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