MEDICARE: ENT ASSOCIATES OF SOUTH FLORIDA LLC

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	207YS0123X	Facial Plastic Surgery Physician

General Provider Information

NPI Number	:	1356568307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENT ASSOCIATES OF SOUTH FLORIDA LLC

Provider Business Mailing Address
First Line	:	9311 W SAMPLE RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4101
Country	:	US
Telephone Number	:	954-755-8885
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 RIVERSIDE DR
Second Line	:	SUITE 105
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6260
Country	:	US
Telephone Number	:	954-345-9191
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. SHAWN PETER SABGA
Credential	:
Telephone Number	:	954-755-8885

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/16/2007

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