Provider Demographics
NPI:1164813242
Name:SFM SURGERY II, LLC
Entity Type:Organization
Organization Name:SFM SURGERY II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-795-9845
Mailing Address - Street 1:3343 STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8002
Mailing Address - Country:US
Mailing Address - Phone:561-795-9845
Mailing Address - Fax:561-791-8742
Practice Address - Street 1:12160 S SHORE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6504
Practice Address - Country:US
Practice Address - Phone:561-798-7494
Practice Address - Fax:561-746-1162
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH FLORIDA MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78137208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008584100Medicaid
FL008584100Medicaid
FLG94716Medicare UPIN