Healthcare Provider Details

I. General information

NPI: 1477161214
Provider Name (Legal Business Name): RADIUS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 E COMMERCIAL BLVD STE 203
FORT LAUDERDALE FL
33308-4062
US

IV. Provider business mailing address

2425 E COMMERCIAL BLVD STE 203
FORT LAUDERDALE FL
33308-4062
US

V. Phone/Fax

Practice location:
  • Phone: 954-931-9787
  • Fax:
Mailing address:
  • Phone: 954-931-9787
  • Fax: 954-915-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD WALTZER
Title or Position: CEO
Credential:
Phone: 954-931-9787