MEDICARE: ORTHOPAEDIC SPINE & FRACTURE OF PALM BEACH, 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	207XS0117X	Orthopaedic Surgery of the Spine Physician	ME81924	FL

General Provider Information

NPI Number	:	1487896213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPAEDIC SPINE & FRACTURE OF PALM BEACH, LLC

Provider Business Mailing Address
First Line	:	8136 OKEECHOBEE BLVD STE A&B
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2002
Country	:	US
Telephone Number	:	561-242-1174
Fax Number	:	561-242-1197

Provider Business Practice Location Address
First Line	:	1019 N STATE ROAD 7 STE B
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-5117
Country	:	US
Telephone Number	:	561-296-2345
Fax Number	:	561-296-2346

Authorized Official
Title or Position	:	CHEIF FINANCIAL OFFICER
Name	:	MR. SHAHMIR QURAESHI
Credential	:
Telephone Number	:	561-242-1174

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	03/25/2009

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