Provider Demographics
NPI:1700995198
Name:ORTHO DESIGN INC
Entity Type:Organization
Organization Name:ORTHO DESIGN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BUKACHESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-797-0181
Mailing Address - Street 1:447 NW 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1608
Mailing Address - Country:US
Mailing Address - Phone:954-797-0181
Mailing Address - Fax:954-797-0332
Practice Address - Street 1:447 NW 73RD AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1608
Practice Address - Country:US
Practice Address - Phone:954-797-0181
Practice Address - Fax:954-797-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT11332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032336500Medicaid
FL4865110001Medicare NSC