MEDICARE: ROBERT B CONTRUCCI DO

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	207Y00000X	Otolaryngology Physician	OS4786	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	:	1104810811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT B CONTRUCCI DO

Provider Business Mailing Address
First Line	:	10071 PINES BLVD
Second Line	:	SUITE C
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6181
Country	:	US
Telephone Number	:	954-437-5333
Fax Number	:	954-437-6252

Provider Business Practice Location Address
First Line	:	10071 PINES BLVD
Second Line	:	SUITE C
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6181
Country	:	US
Telephone Number	:	954-437-5333
Fax Number	:	954-437-6252

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	11/17/2023

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