Provider Demographics
NPI:1437397494
Name:MINIMALLY INVASIVE COLON AND RECTAL SURGERY OF SOUTH FLORIDA PLLC
Entity Type:Organization
Organization Name:MINIMALLY INVASIVE COLON AND RECTAL SURGERY OF SOUTH FLORIDA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AVRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BELIZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-381-5991
Mailing Address - Street 1:4800 LINTON BLVD
Mailing Address - Street 2:BLDG D SUITE 502B
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6584
Mailing Address - Country:US
Mailing Address - Phone:561-381-5991
Mailing Address - Fax:561-381-5275
Practice Address - Street 1:4800 LINTON BLVD
Practice Address - Street 2:BLDG D SUITE 502B
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6584
Practice Address - Country:US
Practice Address - Phone:561-381-5991
Practice Address - Fax:561-381-5275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98306208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty