Healthcare Provider Details

I. General information

NPI: 1467816918
Provider Name (Legal Business Name): SMART SINUS AND ALLERGY FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E WOODFIELD RD SUITE 140
SCHAUMBURG IL
60173-5116
US

IV. Provider business mailing address

822 A1A N SUITE 310
PONTE VEDRA FL
32082-3260
US

V. Phone/Fax

Practice location:
  • Phone: 847-278-1885
  • Fax: 630-635-2496
Mailing address:
  • Phone: 847-278-1885
  • Fax: 630-635-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberME125271
License Number StateFL

VIII. Authorized Official

Name: DR. MIR JOFFREY
Title or Position: MD
Credential: MD
Phone: 847-278-1885