Provider Demographics
NPI:1447928643
Name:COMPREHENSIVE MEDICAL & RESEARCH CENTER LLC
Entity type:Organization
Organization Name:COMPREHENSIVE MEDICAL & RESEARCH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:TILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-714-3912
Mailing Address - Street 1:150 NW 70TH AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2911
Mailing Address - Country:US
Mailing Address - Phone:954-368-3529
Mailing Address - Fax:954-333-2629
Practice Address - Street 1:150 NW 70TH AVE STE 10
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2911
Practice Address - Country:US
Practice Address - Phone:954-368-3529
Practice Address - Fax:954-333-2629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty