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General NPI Number Information
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NPI Number | 1861697096
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Entity Type | Organization
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Legal Business Name | AVENTURA SURGICAL GROUP
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 21110 BISCAYNE BLVD STE 400
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City | AVENTURA
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State | FL
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Zip | 33180-1252
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Country | US
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Telephone | 305-933-8622
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Fax | 305-682-8430
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Provider Business Mailing Address
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Address Line | 21110 BISCAYNE BLVD STE 400
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City | AVENTURA
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State | FL
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Zip | 33180-1252
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Country | US
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Telephone | 305-933-8622
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Fax | 305-682-8430
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SHANNON MICHELLE SMITH
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Credential |
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Telephone | 305-933-8622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OS0003845
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License Number State | FL
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