Healthcare Provider Details

I. General information

NPI: 1316381635
Provider Name (Legal Business Name): GENESISCARE USA OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 N UNIVERSITY DR STE A
CORAL SPRINGS FL
33071-6027
US

IV. Provider business mailing address

1419 SE 8TH TER STE 200
CAPE CORAL FL
33990-3213
US

V. Phone/Fax

Practice location:
  • Phone: 954-227-6747
  • Fax: 954-227-6783
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: IAN WONG
Title or Position: CFO
Credential:
Phone: 303-249-7486