Healthcare Provider Details

I. General information

NPI: 1437397494
Provider Name (Legal Business Name): MINIMALLY INVASIVE COLON AND RECTAL SURGERY OF SOUTH FLORIDA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 LINTON BLVD BLDG D SUITE 502B
DELRAY BEACH FL
33445-6584
US

IV. Provider business mailing address

4800 LINTON BLVD BLDG D SUITE 502B
DELRAY BEACH FL
33445-6584
US

V. Phone/Fax

Practice location:
  • Phone: 561-381-5991
  • Fax: 561-381-5275
Mailing address:
  • Phone: 561-381-5991
  • Fax: 561-381-5275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME98306
License Number StateFL

VIII. Authorized Official

Name: DR. AVRAHAM BELIZON
Title or Position: PRESIDENT
Credential: MD
Phone: 561-381-5991