Provider Demographics
NPI:1013547595
Name:KM ORTHOPEDIC SURGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:KM ORTHOPEDIC SURGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:KOJO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARFO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-889-6012
Mailing Address - Street 1:121 NE 3RD ST APT 2305
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1061
Mailing Address - Country:US
Mailing Address - Phone:856-889-6012
Mailing Address - Fax:
Practice Address - Street 1:7710 NW 71ST CT STE 205
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2931
Practice Address - Country:US
Practice Address - Phone:954-747-1221
Practice Address - Fax:954-747-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty