Provider Demographics
NPI:1942743802
Name:SVM-MED,LLC
Entity Type:Organization
Organization Name:SVM-MED,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:STARIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-204-0054
Mailing Address - Street 1:1920 E HALLANDALE BEACH BLVD STE 901
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4726
Mailing Address - Country:US
Mailing Address - Phone:954-204-0054
Mailing Address - Fax:954-505-4491
Practice Address - Street 1:1920 E HALLANDALE BEACH BLVD STE 901
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009
Practice Address - Country:US
Practice Address - Phone:954-204-0054
Practice Address - Fax:954-505-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11645207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty