MEDICARE: VALUECARE MEDICAL, 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	207Q00000X	Family Medicine Physician	OS8247	FL

General Provider Information

NPI Number	:	1861625287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALUECARE MEDICAL, LLC

Provider Business Mailing Address
First Line	:	6099 STIRLING RD
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-7234
Country	:	US
Telephone Number	:	954-581-7660
Fax Number	:	954-587-2075

Provider Business Practice Location Address
First Line	:	3001 N STATE ROAD 7
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-1913
Country	:	US
Telephone Number	:	954-486-3753
Fax Number	:	954-484-7484

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JARROD MARC FRYDMAN
Credential	:	D.O.
Telephone Number	:	954-581-8272

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	10/21/2009

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