Healthcare Provider Details

I. General information

NPI: 1124395553
Provider Name (Legal Business Name): AVENTURA ORTHO & SPORTS MED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 NE 123RD STREET
NORTH MIAMI FL
33181-2904
US

IV. Provider business mailing address

660 GLADES RD
BOCA RATON FL
33431-6465
US

V. Phone/Fax

Practice location:
  • Phone: 786-923-3000
  • Fax: 786-923-3002
Mailing address:
  • Phone: 561-300-1779
  • Fax: 561-300-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME86710
License Number StateFL

VIII. Authorized Official

Name: MR. DANE TRASK
Title or Position: COO
Credential:
Phone: 813-787-1128