Provider Demographics
NPI:1336560853
Name:SOUTH FLORIDA NEUROSURGERY
Entity Type:Organization
Organization Name:SOUTH FLORIDA NEUROSURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:G
Authorized Official - Last Name:KOURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-410-5110
Mailing Address - Street 1:5503 S CONGRESS AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6626
Mailing Address - Country:US
Mailing Address - Phone:561-410-5110
Mailing Address - Fax:
Practice Address - Street 1:5503 S CONGRESS AVE STE 204
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6626
Practice Address - Country:US
Practice Address - Phone:561-410-5110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-31
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87558207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU8173ZMedicare PIN