Healthcare Provider Details

I. General information

NPI: 1023575834
Provider Name (Legal Business Name): ORTHO FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SW 87TH AVE STE A-110
MIAMI FL
33173-3570
US

IV. Provider business mailing address

751 PARK OF COMMERCE DR STE 112
BOCA RATON FL
33487-3622
US

V. Phone/Fax

Practice location:
  • Phone: 305-596-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ADRIANA WEICHT
Title or Position: COO
Credential:
Phone: 561-300-1792