MEDICARE: DELEEUWS FAMILY CLINIC

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	:	1700945243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELEEUWS FAMILY CLINIC

Provider Business Mailing Address
First Line	:	599 S FEDERAL HWY
Second Line	:
City	:	DANIA BEACH
State	:	FL
Zip	:	33004-4107
Country	:	US
Telephone Number	:	954-920-4911
Fax Number	:	954-922-9308

Provider Business Practice Location Address
First Line	:	599 S FEDERAL HWY
Second Line	:
City	:	DANIA BEACH
State	:	FL
Zip	:	33004-4107
Country	:	US
Telephone Number	:	954-920-4911
Fax Number	:	954-922-9308

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SALLY GORDON
Credential	:
Telephone Number	:	954-920-4911

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	08/22/2020

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