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General NPI Number Information
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NPI Number | 1467816918
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Entity Type | Organization
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Legal Business Name | SMART SINUS AND ALLERGY FLORIDA LLC
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 1100 E WOODFIELD RD SUITE 140
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City | SCHAUMBURG
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State | IL
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Zip | 60173-5116
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Country | US
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Telephone | 847-278-1885
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Fax | 630-635-2496
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Provider Business Mailing Address
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Address Line | 822 A1A N SUITE 310
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City | PONTE VEDRA
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State | FL
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Zip | 32082-3260
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Country | US
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Telephone | 847-278-1885
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Fax | 630-635-2496
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Authorized Official
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Title or Position | MD
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Name | DR. MIR JOFFREY
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Credential | MD
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Telephone | 847-278-1885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | ME125271
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License Number State | FL
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