Healthcare Provider Details

I. General information

NPI: 1568552321
Provider Name (Legal Business Name): SOUTH FLORIDA VASCULAR ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W HILLSBORO BLVD STE 107
COCONUT CREEK FL
33073-4395
US

IV. Provider business mailing address

5300 W HILLSBORO BLVD STE 107
COCONUT CREEK FL
33073-4395
US

V. Phone/Fax

Practice location:
  • Phone: 954-725-4141
  • Fax: 954-725-4141
Mailing address:
  • Phone: 954-725-4141
  • Fax: 954-206-0149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM H JULIEN
Title or Position: PRESIDENT, SFVA
Credential: MD
Phone: 954-725-4141