Healthcare Provider Details

I. General information

NPI: 1063814341
Provider Name (Legal Business Name): BTW MED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 SW 149TH AVE SUITE 400
MIRAMAR FL
33027-4151
US

IV. Provider business mailing address

2901 SW 149TH AVE SUITE 400
MIRAMAR FL
33027-4151
US

V. Phone/Fax

Practice location:
  • Phone: 954-874-4617
  • Fax: 954-239-3902
Mailing address:
  • Phone: 954-874-4617
  • Fax: 954-239-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LYDIA E ARVELO
Title or Position: CREEDENTIALING SPECIALIST
Credential:
Phone: 954-416-1781