Provider Demographics
NPI:1700328440
Name:NICHI SURGICAL LLC
Entity Type:Organization
Organization Name:NICHI SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:N
Authorized Official - Last Name:NICHIPORENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-495-1814
Mailing Address - Street 1:100 E SAMPLE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3554
Mailing Address - Country:US
Mailing Address - Phone:954-495-1814
Mailing Address - Fax:954-301-0720
Practice Address - Street 1:100 E SAMPLE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3554
Practice Address - Country:US
Practice Address - Phone:954-495-1814
Practice Address - Fax:954-301-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107033208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty