Provider Demographics
NPI:1942244868
Name:GASTROENTEROLOGY AND HEPATOLOGY ASSOCIATES OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:GASTROENTEROLOGY AND HEPATOLOGY ASSOCIATES OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:GEDALLOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-430-2343
Mailing Address - Street 1:603 N FLAMINGO RD
Mailing Address - Street 2:SUITE 258
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1023
Mailing Address - Country:US
Mailing Address - Phone:954-430-2343
Mailing Address - Fax:954-438-2983
Practice Address - Street 1:603 N FLAMINGO RD
Practice Address - Street 2:SUITE 258
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1023
Practice Address - Country:US
Practice Address - Phone:954-430-2343
Practice Address - Fax:954-438-2983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 45714207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40577AMedicare ID - Type Unspecified