MEDICARE: GENESISCARE USA 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	208D00000X	General Practice Physician
2	208800000X	Urology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CE7138	OTHER	FL	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1821285826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESISCARE USA OF FLORIDA LLC

Provider Business Mailing Address
First Line	:	1419 SE 8TH TER STE 200
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3213
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	601 N FLAMINGO RD STE 319
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-1011
Country	:	US
Telephone Number	:	954-987-3010
Fax Number	:	954-987-0032

Authorized Official
Title or Position	:	CFO
Name	:	IAN WONG
Credential	:
Telephone Number	:	303-249-7486

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	11/03/2025

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Directions to “GENESISCARE USA OF FLORIDA LLC ” Practice Location

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