Healthcare Provider Details

I. General information

NPI: 1528397056
Provider Name (Legal Business Name): INTEGRATIVE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD SUITE 105
MIAMI BEACH FL
33140-2891
US

IV. Provider business mailing address

PO BOX 403506
MIAMI BEACH FL
33140-1506
US

V. Phone/Fax

Practice location:
  • Phone: 786-522-9968
  • Fax: 305-571-7838
Mailing address:
  • Phone: 786-522-9968
  • Fax: 305-571-7838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME93472
License Number StateFL

VIII. Authorized Official

Name: DR. CAROLYN BETH MESSERE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 786-522-9968