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General NPI Number Information
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NPI Number | 1669954707
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR SURGICAL SUITES LLC
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 825 CORAL RIDGE DRIVE
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-4180
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Country | US
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Telephone | 954-510-9560
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Fax | 954-510-9565
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Provider Business Mailing Address
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Address Line | 825 CORAL RIDGE DRIVE
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-4180
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Country | US
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Telephone | 954-510-9560
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Fax | 954-510-9565
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Authorized Official
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Title or Position | CEO
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Name | MR. OLEG GUTNIK
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Credential | M.D.
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Telephone | 954-510-9560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | FL
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