Provider Demographics
NPI:1992974034
Name:ADVANCED INSTITUTE OF OB GYN
Entity type:Organization
Organization Name:ADVANCED INSTITUTE OF OB GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:MUALIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-983-2101
Mailing Address - Street 1:450 N PARK RD STE 202
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6987
Mailing Address - Country:US
Mailing Address - Phone:954-983-2101
Mailing Address - Fax:954-983-2860
Practice Address - Street 1:450 N PARK RD STE 202
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6987
Practice Address - Country:US
Practice Address - Phone:954-983-2101
Practice Address - Fax:954-983-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86605207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH45933Medicare UPIN