Healthcare Provider Details

I. General information

NPI: 1295248854
Provider Name (Legal Business Name): GALXY ORTHOPEDIC & SPINE CENTER ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 NW 7TH ST
MIAMI FL
33125-3448
US

IV. Provider business mailing address

1951 NW 7TH ST
MIAMI FL
33125-3448
US

V. Phone/Fax

Practice location:
  • Phone: 786-360-5051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: LOUIS M STARACE
Title or Position: REGISTERED AGENT
Credential: MD
Phone: 786-360-5051