Healthcare Provider Details

I. General information

NPI: 1801243209
Provider Name (Legal Business Name): FLORIDA ENDOVASCULAR AND INTERVENTIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 NW 67TH AVE SUITE 101
MIAMI LAKES FL
33014-2174
US

IV. Provider business mailing address

15600 NW 67TH AVE SUITE 101
MIAMI LAKES FL
33014-2174
US

V. Phone/Fax

Practice location:
  • Phone: 954-805-3764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CURTIS L ANDERSON
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 954-805-3764