| 5630 Llc | |
|
5630 Oaktree Ave Fort Lauderdale FL 33312-6375 | |
| (847) 571-4323 | |
| Not Available |
| Full Name | 5630 Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5630 Oaktree Ave, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Sam Judah Sugar (OWNER) |
| Authorized Official Contact | 8475714323 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 5630 Llc 5630 Oaktree Ave Fort Lauderdale FL 33312-6375 Ph: (847) 571-4323 | 5630 Llc 5630 Oaktree Ave Fort Lauderdale FL 33312-6375 Ph: (847) 571-4323 |
| NPI Number | 1942022413 |
|---|---|
| Provider Enumeration Date | 10/28/2024 |
| Last Update Date | 10/28/2024 |
| Medicare PECOS PAC ID | 1658805676 |
|---|---|
| Medicare Enrollment ID | O20241113004728 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942022413 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Sam Sugar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346354529 PECOS PAC ID: 6406763119 Enrollment ID: I20040122000975 |
| Provider Name | Jason Finkelstein |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1750355103 PECOS PAC ID: 0446207393 Enrollment ID: I20210622000216 |
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