Provider Demographics
NPI:1255659330
Name:CORAL RIDGE SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:CORAL RIDGE SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLICKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-557-6159
Mailing Address - Street 1:831 CORAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-4180
Mailing Address - Country:US
Mailing Address - Phone:954-557-6159
Mailing Address - Fax:
Practice Address - Street 1:831 CORAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-4180
Practice Address - Country:US
Practice Address - Phone:954-557-6159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric