MEDICARE: OPTIMA MEDICAL OF SOUTH FLORIDA 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	261QP2300X	Primary Care Clinic/Center	ME 95872	FL

General Provider Information

NPI Number	:	1942507298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMA MEDICAL OF SOUTH FLORIDA INC

Provider Business Mailing Address
First Line	:	2925 10TH AVE N STE 201B
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3046
Country	:	US
Telephone Number	:	561-629-7369
Fax Number	:

Provider Business Practice Location Address
First Line	:	2925 10TH AVE N STE 201B
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3046
Country	:	US
Telephone Number	:	561-629-7369
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EHSANUL KARIM
Credential	:	M.D.
Telephone Number	:	561-629-7369

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	02/23/2011

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