Basic Information
| Provider Information | |||||||||
| NPI: | 1932647930 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED MINIMALLY INVASIVE SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21097 NE 27TH COURT | ||||||||
| Address2: | SUITE 540 | ||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331801235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866232000 | ||||||||
| FaxNumber: | 7863640532 | ||||||||
| Practice Location | |||||||||
| Address1: | 21097 NE 27TH COURT | ||||||||
| Address2: | SUITE 540 | ||||||||
| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331801235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866232000 | ||||||||
| FaxNumber: | 7863640532 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2017 | ||||||||
| LastUpdateDate: | 02/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | FIGUEREO | ||||||||
| AuthorizedOfficialFirstName: | SANTIAGO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7866232000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | ME94748 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.