Healthcare Provider Details

I. General information

NPI: 1861495293
Provider Name (Legal Business Name): SURGICAL GROUP OF MIAMI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 N KENDALL DR SUITE 504W
MIAMI FL
33176-2144
US

IV. Provider business mailing address

PO BOX 201047
DALLAS TX
75320-1047
US

V. Phone/Fax

Practice location:
  • Phone: 305-324-4840
  • 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 NumberAS4136633
License Number StateFL

VIII. Authorized Official

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