Healthcare Provider Details

I. General information

NPI: 1700074226
Provider Name (Legal Business Name): DIGESTIVE DISEASES SERVICES OF SOUTH FLORIDA P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST SUITE 416
HIALEAH FL
33013-3825
US

IV. Provider business mailing address

5501 W 79TH ST SUITE 400
BURBANK IL
60459-1784
US

V. Phone/Fax

Practice location:
  • Phone: 786-493-1551
  • Fax:
Mailing address:
  • Phone: 773-884-4523
  • Fax: 773-884-4580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME57104
License Number StateFL

VIII. Authorized Official

Name: LUIS NASIFF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 786-493-1551