MEDICARE: CLEVELAND PHYSICIANS GROUP & SPA

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1407323041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND PHYSICIANS GROUP & SPA

Provider Business Mailing Address
First Line	:	CLEVELAND PHYSICIANS GROUP & SPA
Second Line	:	582 S.W. FLAGLER AVE.
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	32301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	582 SW FLAGLER AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2836
Country	:	US
Telephone Number	:	954-790-1190
Fax Number	:	954-573-6514

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SIGMUND RINGOEN
Credential	:	D.C.
Telephone Number	:	954-790-1190

Provider Enumeration Date	:	11/01/2018
Last Update Date	:	11/01/2018

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