Healthcare Provider Details

I. General information

NPI: 1215956115
Provider Name (Legal Business Name): JOHN MAXWELL KOFI ABBENSETTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FORT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

2800 E COMMERCIAL BLVD STE 102
FORT LAUDERDALE FL
33308-4202
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number215908
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME125710
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number215908
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME125710
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME125710
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: