Healthcare Provider Details

I. General information

NPI: 1912975780
Provider Name (Legal Business Name): ORTHOPAEDIC SPECIALISTS OF MIAMI BEACH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 N MERIDIAN AVE SUITE 601
MIAMI BEACH FL
33140-2910
US

IV. Provider business mailing address

PO BOX 402125
MIAMI BEACH FL
33140-0125
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-5956
  • Fax:
Mailing address:
  • Phone: 305-674-5956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME58688
License Number StateFL

VIII. Authorized Official

Name: PHILIP RANDALL LOZMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-674-5956