MEDICARE: RED TREE HEALTH 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

General Provider Information

NPI Number	:	1851769145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED TREE HEALTH LLC

Provider Business Mailing Address
First Line	:	2881 E OAKLAND PARK BLVD
Second Line	:	SUITE 448
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1813
Country	:	US
Telephone Number	:	954-881-8230
Fax Number	:	954-315-1702

Provider Business Practice Location Address
First Line	:	2881 E OAKLAND PARK BLVD
Second Line	:	SUITE 448
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1813
Country	:	US
Telephone Number	:	954-881-8230
Fax Number	:	954-315-1702

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID MAYMON
Credential	:
Telephone Number	:	954-881-8230

Provider Enumeration Date	:	09/03/2015
Last Update Date	:	09/03/2015

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Directions to “RED TREE HEALTH LLC ” Practice Location

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