Basic Information
| Provider Information | |||||||||
| NPI: | 1700532090 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH FLORIDA SURGICAL SPECIALISTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 CORAL HILLS DR STE 320 | ||||||||
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| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330654172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547550111 | ||||||||
| FaxNumber: | 9547550243 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 NW 82ND AVE STE 301 | ||||||||
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| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333241855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544242412 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2022 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | SHACHNER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9547550111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.