Healthcare Provider Details

I. General information

NPI: 1467696195
Provider Name (Legal Business Name): SERGIO ALEJANDRO GLAIT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SOUTH PINE ISLAND RD STE 300
PLANTATION FL
33324-3179
US

IV. Provider business mailing address

600 SOUTH PINE ISLAND RD STE 300
PLANTATION FL
33324-3179
US

V. Phone/Fax

Practice location:
  • Phone: 954-473-6344
  • Fax: 954-476-9077
Mailing address:
  • Phone: 954-473-6344
  • Fax: 954-476-9077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME125449
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME125449
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME125449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: