Basic Information
Provider Information
NPI: 1033557806
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATKA
FirstName: JAVED
MiddleName: FIROZ
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 703 N FLAMINGO RD
Address2:  
City: PEMBROKE PINES
State: FL
PostalCode: 330281006
CountryCode: US
TelephoneNumber: 5615706170
FaxNumber:  
Practice Location
Address1: 703 N FLAMINGO RD
Address2:  
City: PEMBROKE PINES
State: FL
PostalCode: 330281006
CountryCode: US
TelephoneNumber: 5615706170
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/13/2013
LastUpdateDate: 06/29/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XOS12967FLY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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