Healthcare Provider Details

I. General information

NPI: 1700110483
Provider Name (Legal Business Name): FLORIDA SPINE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 NORTH FEDERAL HWY
FT LAUDERDALE FL
33308-1772
US

IV. Provider business mailing address

6000 N FEDERAL HWY
FT LAUDERDALE FL
33308-2226
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-2551
  • Fax: 954-492-5266
Mailing address:
  • Phone: 954-771-2551
  • Fax: 954-492-5266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: KALMAN BLUMBERG
Title or Position: PRESIDENT
Credential: MD
Phone: 954-771-2551