Provider Demographics
NPI:1548211972
Name:DR. MICHAEL SURDIS, JR. P.A.
Entity Type:Organization
Organization Name:DR. MICHAEL SURDIS, JR. P.A.
Other - Org Name:ALL BROWARD CHIROPRACTIC AND PAIN REHABILITATION CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FIORENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-894-1797
Mailing Address - Street 1:1561 N PALM AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3229
Mailing Address - Country:US
Mailing Address - Phone:954-443-2420
Mailing Address - Fax:954-443-8422
Practice Address - Street 1:1561 N PALM AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3229
Practice Address - Country:US
Practice Address - Phone:954-443-2420
Practice Address - Fax:954-443-8422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22813OtherFLORIDA BC/BS
FLU50833Medicare UPIN
FL22813Medicare PIN