Provider Demographics
NPI:1710277967
Name:MEDICAL SPECIALISTS OF FORT LAUDERDALE INC
Entity Type:Organization
Organization Name:MEDICAL SPECIALISTS OF FORT LAUDERDALE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-248-3422
Mailing Address - Street 1:8395 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7301
Mailing Address - Country:US
Mailing Address - Phone:954-747-6220
Mailing Address - Fax:954-747-6755
Practice Address - Street 1:8395 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7301
Practice Address - Country:US
Practice Address - Phone:954-747-6220
Practice Address - Fax:954-747-6755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty