Healthcare Provider Details

I. General information

NPI: 1538155197
Provider Name (Legal Business Name): TREASURE COAST THORACIC SURGERY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 US HIGHWAY 1
SEBASTIAN FL
32958-4141
US

IV. Provider business mailing address

816 US HIGHWAY 1
SEBASTIAN FL
32958-4141
US

V. Phone/Fax

Practice location:
  • Phone: 772-581-5848
  • Fax: 772-581-5849
Mailing address:
  • Phone: 772-581-5848
  • Fax: 772-581-5849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. MICHAEL A GREENE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 772-581-5848