Healthcare Provider Details

I. General information

NPI: 1881432466
Provider Name (Legal Business Name): MEDICAL SPECIALISTS OF FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
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

5258 LINTON BLVD STE 203
DELRAY BEACH FL
33484-6529
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 Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: SANJEEV GUPTA
Title or Position: OWNER
Credential: MD
Phone: 954-943-1133