Provider Demographics
NPI:1265519391
Name:CORAL REEF ORTHOPAEDIC ASSOCIATES PA
Entity type:Organization
Organization Name:CORAL REEF ORTHOPAEDIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLHERSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-251-2240
Mailing Address - Street 1:9299 CORAL REEF DR
Mailing Address - Street 2:STE 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157
Mailing Address - Country:US
Mailing Address - Phone:305-251-2240
Mailing Address - Fax:305-238-1517
Practice Address - Street 1:9299 CORAL REEF DR
Practice Address - Street 2:STE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157
Practice Address - Country:US
Practice Address - Phone:305-251-2240
Practice Address - Fax:305-238-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0016257207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91471OtherMEDICARE PROVIDER NUMBER
FL054260100Medicaid
D59653Medicare UPIN