Healthcare Provider Details

I. General information

NPI: 1720707904
Provider Name (Legal Business Name): STAR ORTHOPEDICS AND SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 SHERIDAN ST STE 101
HOLLYWOOD FL
33021-3633
US

IV. Provider business mailing address

1006 WHITE DR
DELRAY BEACH FL
33483-6527
US

V. Phone/Fax

Practice location:
  • Phone: 954-302-8852
  • Fax:
Mailing address:
  • Phone: 561-908-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: HILLARY KOERNER
Title or Position: COO
Credential:
Phone: 561-699-6373