Healthcare Provider Details

I. General information

NPI: 1750646030
Provider Name (Legal Business Name): PALLIATIVE MEDICAL SPECIALTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 07/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SE 17TH ST SUITE 301
FORT LAUDERDALE FL
33316-2547
US

IV. Provider business mailing address

500 SE 17TH ST SUITE 301
FORT LAUDERDALE FL
33316-2547
US

V. Phone/Fax

Practice location:
  • Phone: 954-990-7038
  • Fax: 954-990-7287
Mailing address:
  • Phone: 954-990-7038
  • Fax: 954-990-7287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NEIL MIRANSKY
Title or Position: MGM
Credential: D.O.
Phone: 954-990-7038