Healthcare Provider Details

I. General information

NPI: 1689182362
Provider Name (Legal Business Name): FSS KEYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 12TH ST STE 108
KEY WEST FL
33040-4087
US

IV. Provider business mailing address

6000 N FEDERAL HWY
FORT LAUDERDALE FL
33308-2226
US

V. Phone/Fax

Practice location:
  • Phone: 305-294-9680
  • Fax: 954-492-5266
Mailing address:
  • Phone: 305-294-9680
  • Fax: 954-492-5266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME0056059
License Number StateFL

VIII. Authorized Official

Name: DR. KALMAN DAVID BLUMBERG
Title or Position: OWNER
Credential: MD
Phone: 305-294-9680