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General NPI Number Information
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NPI Number | 1700328440
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Entity Type | Organization
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Legal Business Name | NICHI SURGICAL LLC
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Dates
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Enumeration Date | 11/11/2016
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Last Update Date | 11/11/2016
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Provider Practice Location Address
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Address Line | 100 E SAMPLE RD SUITE 300
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City | POMPANO BEACH
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State | FL
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Zip | 33064-3554
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Country | US
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Telephone | 954-495-1814
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Fax | 954-301-0720
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Provider Business Mailing Address
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Address Line | 100 E SAMPLE RD SUITE 300
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City | POMPANO BEACH
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State | FL
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Zip | 33064-3554
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Country | US
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Telephone | 954-495-1814
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Fax | 954-301-0720
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Authorized Official
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Title or Position | OWNER
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Name | IGOR N NICHIPORENKO
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Credential | MD
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Telephone | 954-495-1814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME107033
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License Number State | FL
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