Provider Demographics
NPI:1033315239
Name:BRUSOVANIK, GEORGIY VLADIMIROVICH (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGIY
Middle Name:VLADIMIROVICH
Last Name:BRUSOVANIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GOSHA
Other - Middle Name:V
Other - Last Name:BRUSOVANIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4770 BISCAYNE BLVD STE 1100
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3247
Mailing Address - Country:US
Mailing Address - Phone:305-467-5678
Mailing Address - Fax:305-821-6782
Practice Address - Street 1:4770 BISCAYNE BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3247
Practice Address - Country:US
Practice Address - Phone:305-467-5678
Practice Address - Fax:305-821-6782
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR-4545207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery