Healthcare Provider Details

I. General information

NPI: 1700434537
Provider Name (Legal Business Name): TRI-COUNTY REGENERATIVE MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 N NOB HILL RD
PLANTATION FL
33322-6548
US

IV. Provider business mailing address

1848 N NOB HILL RD
PLANTATION FL
33322-6548
US

V. Phone/Fax

Practice location:
  • Phone: 544-776-0029
  • Fax:
Mailing address:
  • Phone: 954-477-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL J COHEN
Title or Position: MGR
Credential: DC
Phone: 954-477-6002