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General NPI Number Information
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NPI Number | 1902180391
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Entity Type | Organization
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Legal Business Name | SURGI-HEAL
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 16437 NW 14TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1316
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Country | US
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Telephone | 954-944-2737
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Fax |
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Provider Business Mailing Address
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Address Line | 16437 NW 14TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1316
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN COTTRELL
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Credential |
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Telephone | 954-944-2737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME90795
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH9073
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License Number State | FL
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