Provider Demographics
NPI:1053077305
Name:SOUTH FLORIDA DOCTORS GROUP, PLLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA DOCTORS GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AURELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES CONSUEGRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-442-0784
Mailing Address - Street 1:18503 PINES BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1406
Mailing Address - Country:US
Mailing Address - Phone:954-442-0784
Mailing Address - Fax:855-840-7185
Practice Address - Street 1:1779 N UNIVERSITY DR STE 102
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-0929
Practice Address - Country:US
Practice Address - Phone:954-885-6565
Practice Address - Fax:888-727-7735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023419701Medicaid