Healthcare Provider Details

I. General information

NPI: 1306942602
Provider Name (Legal Business Name): SYNOVATION MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SW 62ND AVE STE 535
SOUTH MIAMI FL
33143-4724
US

IV. Provider business mailing address

PO BOX 12949
MIAMI FL
33101-2949
US

V. Phone/Fax

Practice location:
  • Phone: 786-268-4044
  • Fax: 866-206-8118
Mailing address:
  • Phone: 954-457-0064
  • Fax: 855-490-4044

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: CLAYTON A VARGA
Title or Position: MANAGER-MEMBER
Credential: MD
Phone: 305-428-7733