Basic Information
| Provider Information | |||||||||
| NPI: | 1477989069 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GVB MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7100 W 20TH AVE | ||||||||
| Address2: | SUITE #513 | ||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330161897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054675678 | ||||||||
| FaxNumber: | 3058216782 | ||||||||
| Practice Location | |||||||||
| Address1: | 7100 W 20TH AVE STE 513 | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330161824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054675678 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2013 | ||||||||
| LastUpdateDate: | 03/06/2014 | ||||||||
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| AuthorizedOfficialLastName: | BRUSOVANIK | ||||||||
| AuthorizedOfficialFirstName: | GEORGIY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3054675678 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.