MEDICARE: OBAND MEDICAL GROUP

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	207RB0002X	Obesity Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1598013740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OBAND MEDICAL GROUP

Provider Business Mailing Address
First Line	:	4401 WEST TRADEWINDS AVE
Second Line	:	205
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308
Country	:	US
Telephone Number	:	954-900-3635
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 WEST TRADEWINDS AVE
Second Line	:	205
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308
Country	:	US
Telephone Number	:	954-900-3635
Fax Number	:

Authorized Official
Title or Position	:	CONSULTANT
Name	:	KENNETH WHALEN
Credential	:
Telephone Number	:	561-392-3341

Provider Enumeration Date	:	08/20/2012
Last Update Date	:	08/20/2012

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