Healthcare Provider Details

I. General information

NPI: 1629818851
Provider Name (Legal Business Name): INJURY PHYSICIANS NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 05/27/2024
Certification Date: 05/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 W OAKLAND PARK BLVD
LAUDERHILL FL
33313-1016
US

IV. Provider business mailing address

13911 SW 42ND ST STE 202
MIAMI FL
33175-6407
US

V. Phone/Fax

Practice location:
  • Phone: 305-587-5599
  • Fax: 305-851-0427
Mailing address:
  • Phone: 305-587-5599
  • Fax: 305-851-0427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GUSTAVO MARSHALL JR.
Title or Position: MEMBER
Credential: DC
Phone: 305-587-5599