MEDICARE: US MEDICAL CARE WELLINGTON, 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	208D00000X	General Practice Physician	ME83741	FL
2	207VB0002X	Obesity Medicine (Obstetrics & Gynecology) Physician	ME26716	FL

General Provider Information

NPI Number	:	1689946824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	US MEDICAL CARE WELLINGTON, LLC

Provider Business Mailing Address
First Line	:	11903 SOUTHERN BLVD
Second Line	:	SUIT 108
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-7644
Country	:	US
Telephone Number	:	561-792-2000
Fax Number	:	561-792-2090

Provider Business Practice Location Address
First Line	:	11903 SOUTHERN BLVD
Second Line	:	SUIT 108
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-7644
Country	:	US
Telephone Number	:	561-792-2000
Fax Number	:	561-792-2090

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. SASSON MOULAVI
Credential	:	M.D.
Telephone Number	:	561-445-4489

Provider Enumeration Date	:	02/03/2012
Last Update Date	:	02/03/2012

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