| Organization Name: | GRACE MEDICAL CLINIC |
| NPI Number: | 1124472360 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FREDO SAINT CHARLES (PARTNER) |
| Mailing Address: | 2300 W Oakland Park Blvd Unit 900 Oakland Park |
| State: | FL US |
| Postal Code: | 333111422 |
| Phone Number: | 7723613051 |
| Fax Number: | |
| NPI Enumeration Date: | 04/13/2016 |
| NPI Last Update Date: | 04/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |