Provider Demographics
NPI:1679713838
Name:PAIN MANAGEMENT GROUP OF S FLORIDA INC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT GROUP OF S FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-986-0770
Mailing Address - Street 1:6100 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 409
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7900
Mailing Address - Country:US
Mailing Address - Phone:954-986-0770
Mailing Address - Fax:954-987-8337
Practice Address - Street 1:6100 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 409
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7900
Practice Address - Country:US
Practice Address - Phone:954-986-0770
Practice Address - Fax:954-987-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty