MEDICARE: PEMBROKE PINES PHYSICIANS ASSOCIATES INC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1760546295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEMBROKE PINES PHYSICIANS ASSOCIATES INC

Provider Business Mailing Address
First Line	:	2240 SW 70TH AVE STE D
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33317-7112
Country	:	US
Telephone Number	:	954-430-8000
Fax Number	:	954-212-0150

Provider Business Practice Location Address
First Line	:	2240 SW 70TH AVE STE D
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33317-7112
Country	:	US
Telephone Number	:	954-430-8000
Fax Number	:	954-212-0150

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT M KUSTIN
Credential	:	DC
Telephone Number	:	954-430-8000

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	05/20/2024

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