Provider Demographics
NPI:1841430006
Name:PHYSICIANS OF SOUTH FLORIDA, LLC
Entity type:Organization
Organization Name:PHYSICIANS OF SOUTH FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CERRUTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-924-9955
Mailing Address - Street 1:5020 CLARK RD
Mailing Address - Street 2:#326
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3231
Mailing Address - Country:US
Mailing Address - Phone:941-924-9955
Mailing Address - Fax:941-924-5165
Practice Address - Street 1:5952 CLARK CENTER AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-2715
Practice Address - Country:US
Practice Address - Phone:941-924-9955
Practice Address - Fax:941-924-5165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC10124207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BS219Medicare PIN