Healthcare Provider Details

I. General information

NPI: 1003448242
Provider Name (Legal Business Name): DIGESTIVE HEALTH CENTER OF SOUTH FLORIDA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 WILES RD STE 201
COCONUT CREEK FL
33073-3414
US

IV. Provider business mailing address

4515 WILES RD STE 201
COCONUT CREEK FL
33073-3414
US

V. Phone/Fax

Practice location:
  • Phone: 954-943-1133
  • Fax: 954-783-6845
Mailing address:
  • Phone: 954-943-1133
  • Fax: 954-783-6845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRINAL S GARG
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 954-943-1133