Provider Demographics
NPI:1003212861
Name:TOTAL MD ORTHOPEDICS & NEUROSURGERY LLC
Entity Type:Organization
Organization Name:TOTAL MD ORTHOPEDICS & NEUROSURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-967-8888
Mailing Address - Street 1:6742 FOREST HILL BLVD
Mailing Address - Street 2:STE 291
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-3321
Mailing Address - Country:US
Mailing Address - Phone:561-967-8888
Mailing Address - Fax:
Practice Address - Street 1:401 W COLONIAL DR
Practice Address - Street 2:SUITE 3B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6830
Practice Address - Country:US
Practice Address - Phone:561-967-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5626174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty