Provider Demographics
NPI:1134109747
Name:GENESISCARE USA OF FLORIDA LLC
Entity Type:Organization
Organization Name:GENESISCARE USA OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHADEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARZOUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-931-7254
Mailing Address - Street 1:1419 SE 8TH TER STE 200
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3213
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:7341 GLADIOLUS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-5122
Practice Address - Country:US
Practice Address - Phone:239-489-3420
Practice Address - Fax:239-489-3219
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESISCARE USA INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-19
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060239601Medicaid
FL060239606Medicaid
FL060239609Medicaid
FL060239605Medicaid
FL060239608Medicaid
FL060239612Medicaid
FL060239615Medicaid
FL060239621Medicaid
FLCE9586OtherRAILROAD MEDICARE
FL060239602Medicaid
FL060239604Medicaid
FL060239607Medicaid
FL060239611Medicaid
FL060239600Medicaid
FL060239619Medicaid
FLCE7138OtherRAILROAD MEDICARE
FL060239616Medicaid
FL060239617Medicaid
FLCE7138OtherRAILROAD MEDICARE
FL060239604Medicaid
FL060239605Medicaid
FL060239611Medicaid