Provider Demographics
NPI:1457424293
Name:AVENTURA NEUROSURGERY LLC
Entity Type:Organization
Organization Name:AVENTURA NEUROSURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-548-1089
Mailing Address - Street 1:21097 NE 27 COURT
Mailing Address - Street 2:SUITE 350
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180
Mailing Address - Country:US
Mailing Address - Phone:786-428-1059
Mailing Address - Fax:786-428-1062
Practice Address - Street 1:21097 NE 27 COURT
Practice Address - Street 2:SUITE 350
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:786-428-1059
Practice Address - Fax:786-428-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDD8713OtherRAILROAD MEDICARE
FLDD8713OtherRAILROAD MEDICARE