Healthcare Provider Details

I. General information

NPI: 1457698433
Provider Name (Legal Business Name): COMPREHENSIVE SPINE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 NW 71ST CT SUITE 205
TAMARAC FL
33321-2973
US

IV. Provider business mailing address

PO BOX 15851
PLANTATION FL
33318-5851
US

V. Phone/Fax

Practice location:
  • Phone: 954-747-1221
  • Fax: 954-747-1231
Mailing address:
  • Phone: 954-747-1221
  • Fax: 954-747-1231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME98523
License Number StateFL

VIII. Authorized Official

Name: KADYSHA GUERIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-747-1221