Healthcare Provider Details

I. General information

NPI: 1194220962
Provider Name (Legal Business Name): INDEPENDENT SURGICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 JOHN F KENNEDY DR
ATLANTIS FL
33462-1159
US

IV. Provider business mailing address

3461 FAIRLANE FARMS RD
WELLINGTON FL
33414-8752
US

V. Phone/Fax

Practice location:
  • Phone: 561-439-1500
  • Fax:
Mailing address:
  • Phone: 561-766-1301
  • Fax: 561-693-0539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0002X
TaxonomyObesity Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ARTHUR HANSEN
Title or Position: OWNER
Credential: DPM
Phone: 561-766-1301