Healthcare Provider Details

I. General information

NPI: 1912744426
Provider Name (Legal Business Name): GI HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9655 BOYNTON BEACH BLVD
BOYNTON BEACH FL
33472-4421
US

IV. Provider business mailing address

11818 WINDMILL LAKE DR
BOYNTON BEACH FL
33473-7846
US

V. Phone/Fax

Practice location:
  • Phone: 336-922-7848
  • Fax:
Mailing address:
  • Phone: 561-543-6673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE SHENOUDA
Title or Position: AUTHORIZED OFFICIAL
Credential: DO
Phone: 561-543-6673