Provider Demographics
NPI:1811135858
Name:RESTORATIVE AND PREVENTIVE MEDICINE OF FLORIDA, LLC
Entity type:Organization
Organization Name:RESTORATIVE AND PREVENTIVE MEDICINE OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-371-2255
Mailing Address - Street 1:5831 BEE RIDGE RD STE 310
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5005
Mailing Address - Country:US
Mailing Address - Phone:941-371-2255
Mailing Address - Fax:941-921-8742
Practice Address - Street 1:5831 BEE RIDGE RD STE 310
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5005
Practice Address - Country:US
Practice Address - Phone:941-371-2255
Practice Address - Fax:941-921-8742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 25334261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55807Medicare UPIN