MEDICARE: PALLIATIVE MEDICAL SPECIALTIES 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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) 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	:	1750646030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALLIATIVE MEDICAL SPECIALTIES LLC

Provider Business Mailing Address
First Line	:	500 SE 17TH ST
Second Line	:	SUITE 301
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2547
Country	:	US
Telephone Number	:	954-990-7038
Fax Number	:	954-990-7287

Provider Business Practice Location Address
First Line	:	500 SE 17TH ST
Second Line	:	SUITE 301
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2547
Country	:	US
Telephone Number	:	954-990-7038
Fax Number	:	954-990-7287

Authorized Official
Title or Position	:	MGM
Name	:	DR. NEIL MIRANSKY
Credential	:	D.O.
Telephone Number	:	954-990-7038

Provider Enumeration Date	:	07/12/2012
Last Update Date	:	07/19/2015

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