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General NPI Number Information
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NPI Number | 1033315239
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Entity Type | Individual
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Provider Name | GEORGIY VLADIMIROVICH BRUSOVANIK MD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 4770 BISCAYNE BLVD STE 1100
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City | MIAMI
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State | FL
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Zip | 33137-3247
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Country | US
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Telephone | 305-467-5678
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Fax | 305-821-6782
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Provider Business Mailing Address
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Address Line | 4770 BISCAYNE BLVD STE 1100
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City | MIAMI
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State | FL
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Zip | 33137-3247
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Country | US
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Telephone | 305-467-5678
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Fax | 305-821-6782
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MDR-4545
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License Number State | HI
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