Provider Demographics
NPI:1164526802
Name:BIRKEN, GARY A (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:BIRKEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:STE 555
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-981-0072
Practice Address - Fax:954-981-0188
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2020-02-04
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Provider Licenses
StateLicense IDTaxonomies
FLME487412086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043354300Medicaid
D63252Medicare UPIN
94497Medicare ID - Type Unspecified