Healthcare Provider Details

I. General information

NPI: 1467491977
Provider Name (Legal Business Name): LYLE HURWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S CONGRESS AVE #211
ATLANTIS FL
33462-6635
US

IV. Provider business mailing address

5401 S CONGRESS AVE STE 211
ATLANTIS FL
33462-6637
US

V. Phone/Fax

Practice location:
  • Phone: 561-964-8221
  • Fax: 561-964-7393
Mailing address:
  • Phone: 561-964-8221
  • Fax: 561-964-7393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME72040
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: