Provider Demographics
NPI:1376530733
Name:DIGESTIVE DISEASE ASSOCIATES OF SOUTH FLORIDA, PA
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE ASSOCIATES OF SOUTH FLORIDA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNISKERN
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA, MBA
Authorized Official - Phone:954-721-5400
Mailing Address - Street 1:7475 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2971
Mailing Address - Country:US
Mailing Address - Phone:954-721-5400
Mailing Address - Fax:954-601-0467
Practice Address - Street 1:7475 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2971
Practice Address - Country:US
Practice Address - Phone:954-721-5400
Practice Address - Fax:954-601-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty