Healthcare Provider Details

I. General information

NPI: 1174685127
Provider Name (Legal Business Name): MITCHELL S SEAVEY MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 N FEDERAL HWY SUITE 2
FORT LAUDERDALE FL
33308-2600
US

IV. Provider business mailing address

5700 N FEDERAL HWY SUITE 2
FORT LAUDERDALE FL
33308-2600
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-7760
  • Fax:
Mailing address:
  • Phone: 954-771-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberME0049150
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME0049150
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberME0049150
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0049150
License Number StateFL

VIII. Authorized Official

Name: DR. MITCHELL S SEAVEY
Title or Position: PRESIDENT
Credential: MD
Phone: 954-771-7760