MEDICARE: MEDICUS MEDICI PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053988105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICUS MEDICI PLLC

Provider Business Mailing Address
First Line	:	5630 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6351
Country	:	US
Telephone Number	:	757-672-4240
Fax Number	:

Provider Business Practice Location Address
First Line	:	5630 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6351
Country	:	US
Telephone Number	:	757-672-4240
Fax Number	:

Authorized Official
Title or Position	:	MBR
Name	:	DR. JOSE E SANTORO
Credential	:	MD
Telephone Number	:	757-672-4240

Provider Enumeration Date	:	06/08/2021
Last Update Date	:	06/08/2021

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Directions to “MEDICUS MEDICI PLLC ” Practice Location

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