MEDICARE: PERFORMANCE ORTHOPAEDICS OF 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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1801198205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE ORTHOPAEDICS OF FLORIDA, LLC

Provider Business Mailing Address
First Line	:	721 SE 17TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2983
Country	:	US
Telephone Number	:	954-765-3200
Fax Number	:	954-765-3206

Provider Business Practice Location Address
First Line	:	721 SE 17TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2983
Country	:	US
Telephone Number	:	954-765-3200
Fax Number	:	954-765-3206

Authorized Official
Title or Position	:	MEDICAL BILLER
Name	:	MRS. EVELYN FISCALETTI
Credential	:
Telephone Number	:	754-234-6975

Provider Enumeration Date	:	11/17/2010
Last Update Date	:	11/17/2010

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