Provider Demographics
NPI:1386855195
Name:SOUTH FLORIDA MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:SOUTH FLORIDA MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-596-3300
Mailing Address - Street 1:1745 WINDING OAKS WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-1456
Mailing Address - Country:US
Mailing Address - Phone:239-596-3300
Mailing Address - Fax:239-596-3398
Practice Address - Street 1:9150 GALLERIA CT
Practice Address - Street 2:SUITE #200
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-4379
Practice Address - Country:US
Practice Address - Phone:239-596-3300
Practice Address - Fax:239-596-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0003618207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2221Medicare ID - Type Unspecified
FLC30012Medicare UPIN