Healthcare Provider Details

I. General information

NPI: 1023091246
Provider Name (Legal Business Name): THE GI GROUP OF SOUTH FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16855 NE 2ND AVE SUITE 202
NORTH MIAMI BEACH FL
33162-1744
US

IV. Provider business mailing address

16855 NE 2ND AVE SUITE 202
NORTH MIAMI BEACH FL
33162-1744
US

V. Phone/Fax

Practice location:
  • Phone: 305-770-0062
  • Fax: 305-770-1060
Mailing address:
  • Phone: 305-770-0062
  • Fax: 305-770-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICARDO J ROMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 305-770-0062