MEDICARE: AVICENNA SOLUTIONS 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	261QR1100X	Research Clinic/Center

General Provider Information

NPI Number	:	1548611163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVICENNA SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	4602 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-5206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4602 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-5206
Country	:	US
Telephone Number	:	954-491-4888
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL INVESTIGATOR
Name	:	DR. BEHNAM BIRGANI
Credential	:
Telephone Number	:	561-290-3873

Provider Enumeration Date	:	06/24/2016
Last Update Date	:	06/24/2016

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