Healthcare Provider Details

I. General information

NPI: 1689660367
Provider Name (Legal Business Name): IHOR PIDHORECKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7630 SW 34TH MNR STE 450
DAVIE FL
33328-1987
US

IV. Provider business mailing address

2301 N UNIVERSITY DR STE 204
PEMBROKE PINES FL
33024-3617
US

V. Phone/Fax

Practice location:
  • Phone: 954-372-1429
  • Fax: 954-744-4519
Mailing address:
  • Phone: 954-372-1429
  • Fax: 954-744-4519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberME80863
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: