Provider Demographics
NPI:1386655157
Name:SURGICAL PARK ANESTHESIA GROUP PA
Entity Type:Organization
Organization Name:SURGICAL PARK ANESTHESIA GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KRANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-271-9100
Mailing Address - Street 1:PO BOX 162040
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-2040
Mailing Address - Country:US
Mailing Address - Phone:305-271-9100
Mailing Address - Fax:305-270-8527
Practice Address - Street 1:9100 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2303
Practice Address - Country:US
Practice Address - Phone:305-271-9100
Practice Address - Fax:305-270-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72294Medicare ID - Type Unspecified