Provider Demographics
NPI:1982012357
Name:SOUTH FLORIDA PULMONARY, LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA PULMONARY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:O
Authorized Official - Last Name:KATEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-637-6739
Mailing Address - Street 1:4760 W. ATLANTIC AVE.
Mailing Address - Street 2:STE. B
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445
Mailing Address - Country:US
Mailing Address - Phone:561-637-6739
Mailing Address - Fax:561-303-2140
Practice Address - Street 1:4760 W. ATLANTIC AVE.
Practice Address - Street 2:STE. B
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445
Practice Address - Country:US
Practice Address - Phone:561-637-6739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65317207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF16017Medicare UPIN