MEDICARE: WZRD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	261QH0100X	Health Service Clinic/Center
3	261QM2500X	Medical Specialty Clinic/Center
4	261QP2300X	Primary Care Clinic/Center
5	261QU0200X	Urgent Care Clinic/Center
6	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1962090993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WZRD, LLC

Provider Business Mailing Address
First Line	:	6813 FINAMORE CIR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-8727
Country	:	US
Telephone Number	:	954-483-3381
Fax Number	:	954-516-0720

Provider Business Practice Location Address
First Line	:	1010 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-1608
Country	:	US
Telephone Number	:	954-483-3381
Fax Number	:	954-516-0720

Authorized Official
Title or Position	:	OWNER, AUTHORIZED OFFICIAL
Name	:	DR. KHALED DEEB
Credential	:	MD, PHD, MBA
Telephone Number	:	954-483-3811

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	04/02/2023

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