Provider Demographics
NPI:1346254158
Name:PALMETTO FERTILITY CENTER OF SOUTH FLORIDA, INC
Entity Type:Organization
Organization Name:PALMETTO FERTILITY CENTER OF SOUTH FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GRAUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-558-0808
Mailing Address - Street 1:7100 W 20TH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1897
Mailing Address - Country:US
Mailing Address - Phone:305-558-0808
Mailing Address - Fax:305-558-0806
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:SUITE 412
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5593
Practice Address - Country:US
Practice Address - Phone:954-538-1440
Practice Address - Fax:954-447-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL72801207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty