Healthcare Provider Details

I. General information

NPI: 1033315239
Provider Name (Legal Business Name): GEORGIY VLADIMIROVICH BRUSOVANIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GOSHA V BRUSOVANIK MD

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 BISCAYNE BLVD STE 1100
MIAMI FL
33137-3247
US

IV. Provider business mailing address

4770 BISCAYNE BLVD STE 1100
MIAMI FL
33137-3247
US

V. Phone/Fax

Practice location:
  • Phone: 305-467-5678
  • Fax: 305-821-6782
Mailing address:
  • Phone: 305-467-5678
  • Fax: 305-821-6782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMDR-4545
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: