=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093183469
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE ATHLETE'S CLINIC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2015
-----------------------------------------------------
Last Update Date | 09/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8201 PETERS RD SUITE 1000
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-3265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-774-8784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8201 PETERS RD SUITE 1000
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-3265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-774-8784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. MICHAEL J DEFRANCO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 954-774-8784
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | ME119307
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207XS0114X
-----------------------------------------------------
Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | ME119307
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | ME119307
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------