Healthcare Provider Details

I. General information

NPI: 1457078248
Provider Name (Legal Business Name): T.I.O MEDICAL INTERVENTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 S UNIVERSITY DR SUITE 109
PLANTATION FL
33324
US

IV. Provider business mailing address

817 S UNIVERSITY DR SUITE 119
PLANTATION FL
33324
US

V. Phone/Fax

Practice location:
  • Phone: 954-279-2170
  • Fax: 954-424-9533
Mailing address:
  • Phone: 954-279-2170
  • Fax: 954-424-9533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARISA MERLO
Title or Position: ADMINISTRATION
Credential:
Phone: 954-279-2170