Provider Demographics
NPI:1033487509
Name:BROWARD PLASTIC SURGERY, PA
Entity Type:Organization
Organization Name:BROWARD PLASTIC SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SACHSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-202-9898
Mailing Address - Street 1:2818 E OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1814
Mailing Address - Country:US
Mailing Address - Phone:954-202-9898
Mailing Address - Fax:954-202-9112
Practice Address - Street 1:2818 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1814
Practice Address - Country:US
Practice Address - Phone:954-202-9898
Practice Address - Fax:954-202-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 49596208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257295800Medicaid