MEDICARE: BROWARD PLASTIC SURGERY, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	ME 49596	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033487509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWARD PLASTIC SURGERY, PA

Provider Business Mailing Address
First Line	:	2818 E OAKLAND PARK BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1814
Country	:	US
Telephone Number	:	954-202-9898
Fax Number	:	954-202-9112

Provider Business Practice Location Address
First Line	:	2818 E OAKLAND PARK BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1814
Country	:	US
Telephone Number	:	954-202-9898
Fax Number	:	954-202-9112

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SUSANNE SACHSE
Credential	:
Telephone Number	:	954-202-9898

Provider Enumeration Date	:	12/12/2011
Last Update Date	:	05/05/2020

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