Healthcare Provider Details

I. General information

NPI: 1194845362
Provider Name (Legal Business Name): MAX CHERELUS CRTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SW 49TH TER
MARGATE FL
33068-3123
US

IV. Provider business mailing address

801 SW 49TH TER
MARGATE FL
33068-3123
US

V. Phone/Fax

Practice location:
  • Phone: 954-956-8279
  • Fax:
Mailing address:
  • Phone: 954-956-8279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT 12145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: