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General NPI Number Information
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NPI Number | 1427677038
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Entity Type | Organization
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Legal Business Name | GENESISCARE USA OF FLORIDA LLC
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 36468 EMERALD COAST PKWY STE 11103
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City | DESTIN
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State | FL
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Zip | 32541-0741
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Country | US
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Telephone | 850-660-5204
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Fax | 850-660-5206
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Provider Business Mailing Address
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Address Line | 1419 SE 8TH TER STE 200
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City | CAPE CORAL
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State | FL
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Zip | 33990-3213
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHADEN MARZOUK
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Credential |
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Telephone | 239-931-7254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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