Healthcare Provider Details

I. General information

NPI: 1710277967
Provider Name (Legal Business Name): MEDICAL SPECIALISTS OF FORT LAUDERDALE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8395 W OAKLAND PARK BLVD SUITE A
SUNRISE FL
33351-7301
US

IV. Provider business mailing address

8395 W OAKLAND PARK BLVD SUITE A
SUNRISE FL
33351-7301
US

V. Phone/Fax

Practice location:
  • Phone: 954-747-6220
  • Fax: 954-747-6755
Mailing address:
  • Phone: 954-747-6220
  • Fax: 954-747-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JACOB GITMAN
Title or Position: CEO
Credential:
Phone: 954-248-3422