Provider Demographics
NPI:1124395553
Name:AVENTURA ORTHO & SPORTS MED, LLC
Entity Type:Organization
Organization Name:AVENTURA ORTHO & SPORTS MED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRASK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-787-1128
Mailing Address - Street 1:660 GLADES RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6465
Mailing Address - Country:US
Mailing Address - Phone:561-300-1779
Mailing Address - Fax:561-300-1879
Practice Address - Street 1:2260 NE 123RD STREET
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2904
Practice Address - Country:US
Practice Address - Phone:786-923-3000
Practice Address - Fax:786-923-3002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHO FLORIDA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-30
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86710207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty