Provider Demographics
NPI:1962860197
Name:ORTHOPEDIC SPECIALTY INSTIUTE, PLLC
Entity Type:Organization
Organization Name:ORTHOPEDIC SPECIALTY INSTIUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-986-7079
Mailing Address - Street 1:3990 SHERIDAN ST
Mailing Address - Street 2:SUITE 106-107
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3661
Mailing Address - Country:US
Mailing Address - Phone:954-986-7079
Mailing Address - Fax:954-986-1331
Practice Address - Street 1:3990 SHERIDAN ST
Practice Address - Street 2:SUITE 106-107
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3661
Practice Address - Country:US
Practice Address - Phone:954-986-7079
Practice Address - Fax:954-986-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80620207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259837000Medicaid
FL35636Medicaid