Provider Demographics
NPI:1225029705
Name:SOUTH FLORIDA INSTITUTE OF PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA INSTITUTE OF PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:MALGOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-484-9205
Mailing Address - Street 1:10887 NW 17TH ST UNIT 108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2044
Mailing Address - Country:US
Mailing Address - Phone:786-359-4999
Mailing Address - Fax:786-359-4843
Practice Address - Street 1:10887 NW 17TH ST UNIT 108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-2044
Practice Address - Country:US
Practice Address - Phone:786-359-4999
Practice Address - Fax:786-359-4843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7589111N00000X
FLME869352081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00598OtherBLUE CROSS BLUE SHIELD
FL00598OtherBLUE CROSS BLUE SHIELD