Healthcare Provider Details

I. General information

NPI: 1790775112
Provider Name (Legal Business Name): BROWARD ENT CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 N UNIVERSITY DR SUITE 101B
CORAL SPRINGS FL
33067-4646
US

IV. Provider business mailing address

5511 N UNIVERSITY DR SUITE 101B
CORAL SPRINGS FL
33067-4646
US

V. Phone/Fax

Practice location:
  • Phone: 954-755-4002
  • Fax: 954-755-5010
Mailing address:
  • Phone: 954-755-4002
  • Fax: 954-755-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberME85117
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberME85117
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberME85117
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME85117
License Number StateFL

VIII. Authorized Official

Name: RAM KUMAR MADASU
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 954-755-4002