MEDICARE: ICE PULMONARY NETWORK 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	207RP1001X	Pulmonary Disease Physician	ME104425	FL

General Provider Information

NPI Number	:	1982081527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICE PULMONARY NETWORK LLC

Provider Business Mailing Address
First Line	:	17180 ROYAL PALM BLVD SUITE
Second Line	:	STE 3
City	:	WESTON
State	:	FL
Zip	:	33326
Country	:	US
Telephone Number	:	954-482-4747
Fax Number	:	954-301-5939

Provider Business Practice Location Address
First Line	:	17180 ROYAL PALM BLVD
Second Line	:	STE 3
City	:	WESTON
State	:	FL
Zip	:	33326-2394
Country	:	US
Telephone Number	:	954-482-4747
Fax Number	:	954-301-5939

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GUSTAVO FERRER
Credential	:	MD
Telephone Number	:	954-482-4747

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	05/04/2015

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Directions to “ICE PULMONARY NETWORK LLC ” Practice Location

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