Provider Demographics
NPI:1386991966
Name:HEALTH REAL LLC
Entity type:Organization
Organization Name:HEALTH REAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:TAWFIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:KANJ-AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-404-7535
Mailing Address - Street 1:PO BOX 480730
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33348-0730
Mailing Address - Country:US
Mailing Address - Phone:248-404-7535
Mailing Address - Fax:
Practice Address - Street 1:2800 E COMMERCIAL BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4229
Practice Address - Country:US
Practice Address - Phone:248-404-7535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI02811Medicare UPIN