Active NPI
Innovative Care II, LLC
- Family Medicine Physician
- Miramar, FL
National Provider Identifier
1790086023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS10374
- Legal business name
- INNOVATIVE CARE II, LLC
- Practice address
- 12600 Pembroke Rd
Suite 100
Miramar, FL 33027-2544 - Phone
- (954) 843-7230
- Fax
- (877) 671-4101
- NPI assigned
- Nov 3, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gokhan Guvenli, MD
- Title
- Medical Director
- Phone
- (954) 450-9595
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS10374 | FL | Primary |
Addresses
Primary practice location
12600 Pembroke Rd
Suite 100
Miramar, FL 33027-2544
Mailing address
1 SW 129TH Ave Ste 304
Pembroke Pines, FL 33027-1717
Phone (954) 843-7230
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BW654Z | Other | FL | MEDICARE |
| FJ749A | Other | FL | MEDICARE PTAN |
National Provider Directory
National Provider DirectoryLocations
12600 Pembroke Rd
Ste 100
Miramar, FL 33027
Phone (954) 431-7681
1 SW 129th Ave
Ste 304
Pembroke Pines, FL 33027
Phone (954) 422-5400
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288742400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1790086023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 SW 129TH AVE STE 304",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330271717",
"telephone_number": "954-843-7230",
"fax_number": "877-671-4101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12600 PEMBROKE RD",
"address_2": "SUITE 100",
"city": "MIRAMAR",
"state": "FL",
"postal_code": "330272544",
"telephone_number": "954-843-7230",
"fax_number": "877-671-4101"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INNOVATIVE CARE II, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2010-11-03",
"last_updated": "2022-07-21",
"status": "A",
"authorized_official_last_name": "GUVENLI",
"authorized_official_first_name": "GOKHAN",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "954-450-9595",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "FL",
"license": "OS10374",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "BW654Z",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "FJ749A",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Miramar, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.