Provider Demographics
NPI:1780657437
Name:NEUROLOGY GROUP OF SOUTH FL INC
Entity Type:Organization
Organization Name:NEUROLOGY GROUP OF SOUTH FL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-532-2464
Mailing Address - Street 1:4300 ALTON RD
Mailing Address - Street 2:SUITE 2060
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2800
Mailing Address - Country:US
Mailing Address - Phone:305-532-2464
Mailing Address - Fax:305-531-2924
Practice Address - Street 1:4300 ALTON RD
Practice Address - Street 2:SUITE 2060
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2800
Practice Address - Country:US
Practice Address - Phone:305-532-2464
Practice Address - Fax:305-531-2924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21815OtherBLUE CROSS BLUE SHIELD
FLCH5992OtherRAILROAD MEDICARE
FL253816400Medicaid
FL7970545OtherAETNA
FL3001436OtherGHI
FL3001436OtherGHI