Healthcare Provider Details

I. General information

NPI: 1083369623
Provider Name (Legal Business Name): SURGICAL GROUP OF MIAMI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2022
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST
MIAMI FL
33136-2107
US

IV. Provider business mailing address

PO BOX 201074
DALLAS TX
75320-1074
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-5511
  • Fax: 305-545-9562
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARLEE LEBLEU
Title or Position: VICE PRESIDENT
Credential:
Phone: 480-321-7026