Healthcare Provider Details

I. General information

NPI: 1184471104
Provider Name (Legal Business Name): INTERVENTIONAL SPINE SPECIALISTS OF SOUTH FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NE 167TH ST
NORTH MIAMI BEACH FL
33162-3402
US

IV. Provider business mailing address

1 NE 167TH ST
NORTH MIAMI BEACH FL
33162-3402
US

V. Phone/Fax

Practice location:
  • Phone: 305-432-9565
  • Fax: 305-432-9567
Mailing address:
  • Phone: 305-432-9565
  • Fax: 305-432-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: HICHAM SAMIR MERHEB
Title or Position: OWNER
Credential:
Phone: 561-955-0169