Provider Demographics
NPI:1073579074
Name:BICZAK, LAUREEN A (DO)
Entity type:Individual
Prefix:
First Name:LAUREEN
Middle Name:A
Last Name:BICZAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-3000
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:5647 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6325
Practice Address - Country:US
Practice Address - Phone:954-276-1616
Practice Address - Fax:954-276-0186
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17504207RI0200X
ME1167207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112811500Medicaid
1041404OtherAETNA
018025OtherANTHEM
MM2978Medicare ID - Type Unspecified
MEMM297801Medicare PIN
018025OtherANTHEM