Healthcare Provider Details

I. General information

NPI: 1235286386
Provider Name (Legal Business Name): MEDICAL CONSULTANTS OF SOUTH FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 WILES RD SUITE 104
CORAL SPRINGS FL
33067-2063
US

IV. Provider business mailing address

7501 WILES RD SUITE 104
CORAL SPRINGS FL
33067-2063
US

V. Phone/Fax

Practice location:
  • Phone: 954-755-4994
  • Fax: 954-755-4995
Mailing address:
  • Phone: 954-755-4994
  • Fax: 954-755-4995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH6274
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME46569
License Number StateFL

VIII. Authorized Official

Name: RONALD LEWERT
Title or Position: PRESIDENT
Credential: DC
Phone: 954-755-4994