MEDICARE: ULTAMED CORPORATION

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1518683531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTAMED CORPORATION

Provider Business Mailing Address
First Line	:	2307 SEA ISLAND DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1574
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2307 SEA ISLAND DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1574
Country	:	US
Telephone Number	:	949-468-9301
Fax Number	:

Authorized Official
Title or Position	:	CEO/ PRESIDENT
Name	:	LAURA EATON-JANKOV
Credential	:
Telephone Number	:	949-468-9301

Provider Enumeration Date	:	10/12/2022
Last Update Date	:	10/12/2022

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Directions to “ULTAMED CORPORATION ” Practice Location

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