Provider Demographics
NPI:1962512061
Name:SOUTH FLORIDA PEDIATRIC SURGEONS PA
Entity Type:Organization
Organization Name:SOUTH FLORIDA PEDIATRIC SURGEONS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:LEWARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-584-8500
Mailing Address - Street 1:300 N.W. 70TH AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2384
Mailing Address - Country:US
Mailing Address - Phone:954-584-8500
Mailing Address - Fax:954-792-0192
Practice Address - Street 1:300 N.W. 70TH AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33317-2384
Practice Address - Country:US
Practice Address - Phone:954-584-8500
Practice Address - Fax:954-792-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty