Provider Demographics
NPI:1013283803
Name:BURN AND RECONSTRUCTIVE CENTERS OF FLORIDA, INC.
Entity Type:Organization
Organization Name:BURN AND RECONSTRUCTIVE CENTERS OF FLORIDA, INC.
Other - Org Name:BURN AND RECONSTRUCTIVE CENTERS OF FLORIDA, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:MD, MBA
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-822-8955
Mailing Address - Street 1:1561 LAKEFRONT DR UNIT 202
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-1637
Mailing Address - Country:US
Mailing Address - Phone:941-822-8955
Mailing Address - Fax:941-259-0157
Practice Address - Street 1:1561 LAKEFRONT DR UNIT 202
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-1637
Practice Address - Country:US
Practice Address - Phone:941-822-8955
Practice Address - Fax:941-259-0157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty