Healthcare Provider Details

I. General information

NPI: 1083163315
Provider Name (Legal Business Name): ORTHOPEDIC SPECIALTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 BISCAYNE BLVD STE 1100
MIAMI FL
33137-3247
US

IV. Provider business mailing address

2800 BISCAYNE BLVD STE 1010
MIAMI FL
33137-4559
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 NumberME116967
License Number StateFL

VIII. Authorized Official

Name: MELISSA CABRERA
Title or Position: MANAGER
Credential:
Phone: 305-467-5678