Basic Information
| Provider Information | |||||||||
| NPI: | 1952409963 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH FLORIDA SURGICAL SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 CORAL HILLS DR | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330654172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542134741 | ||||||||
| FaxNumber: | 9547552209 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 CORAL HILLS DR | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330654172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542134741 | ||||||||
| FaxNumber: | 9547552209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | GULAREK | ||||||||
| AuthorizedOfficialFirstName: | JUSTIN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9542134741 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 278013500 | 05 | FL | MEDICAID | 278013502 | 05 | FL | MEDICAID | 278013507 | 05 | FL | MEDICAID | 278013503 | 05 | FL | MEDICAID | 278013504 | 05 | FL | MEDICAID | 00643 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 278013501 | 05 | FL | MEDICAID | 278013506 | 05 | FL | MEDICAID | DH1405 | 01 | FL | MEDICARE RAILROAD | OTHER | 278013505 | 05 | FL | MEDICAID |