Provider Demographics
NPI:1871690354
Name:ADVANCED ORTHOPEDIC SURGERY & SPORTS MEDICINE, INC.
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDIC SURGERY & SPORTS MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:KOHLER
Authorized Official - Last Name:EKSTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-251-6051
Mailing Address - Street 1:5258 LINTON BLVD.
Mailing Address - Street 2:305
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484
Mailing Address - Country:US
Mailing Address - Phone:954-251-6051
Mailing Address - Fax:310-824-7600
Practice Address - Street 1:5258 LINTON BLVD.
Practice Address - Street 2:305
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484
Practice Address - Country:US
Practice Address - Phone:954-251-6051
Practice Address - Fax:310-824-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71116207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15342AMedicare ID - Type Unspecified