Healthcare Provider Details

I. General information

NPI: 1841757580
Provider Name (Legal Business Name): MELI ORTHOPEDIC CENTERS OF EXCELLENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NW 82ND AVE STE 102
PLANTATION FL
33324-1853
US

IV. Provider business mailing address

PO BOX 162743
ALTAMONTE SPRINGS FL
32716-2743
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-8177
  • Fax:
Mailing address:
  • Phone: 954-580-4080
  • Fax: 954-530-5069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GERNELL HAMILTON
Title or Position: CREDENTIALING
Credential:
Phone: 954-451-3008