Provider Demographics
NPI:1841527652
Name:ENT AND ALLERGY ASSOCIATES OF FLORIDA, LLC
Entity type:Organization
Organization Name:ENT AND ALLERGY ASSOCIATES OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUM
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, MBA, CMPE
Authorized Official - Phone:561-939-0177
Mailing Address - Street 1:900 NW 13TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2335
Mailing Address - Country:US
Mailing Address - Phone:561-338-3267
Mailing Address - Fax:561-391-4420
Practice Address - Street 1:927 45TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2450
Practice Address - Country:US
Practice Address - Phone:561-848-5579
Practice Address - Fax:561-848-9269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OS10621207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001960300Medicaid
FL001960300Medicaid