MEDICARE: WEST BROWARD INTERNAL MEDICINE PLLC

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	207R00000X	Internal Medicine Physician	ME67283	FL

General Provider Information

NPI Number	:	1871765727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST BROWARD INTERNAL MEDICINE PLLC

Provider Business Mailing Address
First Line	:	6451 W COMMERCIAL BLVD
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-2110
Country	:	US
Telephone Number	:	954-720-1414
Fax Number	:	954-720-4727

Provider Business Practice Location Address
First Line	:	6451 W COMMERCIAL BLVD
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-2110
Country	:	US
Telephone Number	:	954-720-1414
Fax Number	:	954-720-4727

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. SHAHRAD MABOURAKH
Credential	:	M.D.
Telephone Number	:	954-720-1414

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	11/27/2023

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