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General NPI Number Information
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NPI Number | 1700074226
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Entity Type | Organization
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Legal Business Name | DIGESTIVE DISEASES SERVICES OF SOUTH FLORIDA P A
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 777 E 25TH ST SUITE 416
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City | HIALEAH
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State | FL
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Zip | 33013-3825
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Country | US
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Telephone | 786-493-1551
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Fax |
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Provider Business Mailing Address
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Address Line | 5501 W 79TH ST SUITE 400
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City | BURBANK
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State | IL
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Zip | 60459-1784
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Country | US
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Telephone | 773-884-4523
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Fax | 773-884-4580
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Authorized Official
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Title or Position | PRESIDENT
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Name | LUIS NASIFF
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Credential | M.D.
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Telephone | 786-493-1551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME57104
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License Number State | FL
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