Provider Demographics
NPI:1326374901
Name:BERMAX II LLC
Entity Type:Organization
Organization Name:BERMAX II LLC
Other - Org Name:CLEVENS CENTER FOR FACIAL COSMETIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-727-3223
Mailing Address - Street 1:707 W EAU GALLIE BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5958
Mailing Address - Country:US
Mailing Address - Phone:321-727-3223
Mailing Address - Fax:321-727-9448
Practice Address - Street 1:707 W EAU GALLIE BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5958
Practice Address - Country:US
Practice Address - Phone:321-727-3223
Practice Address - Fax:321-727-9448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70285208200000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Single Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty