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General NPI Number Information
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NPI Number | 1477989069
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Entity Type | Organization
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Legal Business Name | GVB MD LLC
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 4770 BISCAYNE BLVD SUITE 1100
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City | MIAMI
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State | FL
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Zip | 33137-4559
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Country | US
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Telephone | 305-467-5678
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Fax |
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Provider Business Mailing Address
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Address Line | 4770 BISCAYNE BLVD SUITE 100
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City | MIAMI
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State | FL
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Zip | 33137-4559
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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 | OWNER
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Name | GEORGIY BRUSOVANIK
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Credential | MD
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Telephone | 305-467-5678
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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 |
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License Number State |
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