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NPI Code Detail

MEDICARE: SFM UROLOGY I LLC

MEDICARE: SFM UROLOGY I LLC
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
1208800000XUrology Physician

General Provider Information

NPI Number : 1194076653
Entity Type Code : Organization
Provider Name (Legal Business Name) : SFM UROLOGY I LLC
Provider Business Mailing Address
First Line : 3230 LAKE WORTH RD
Second Line :
City : PALM SPRINGS
State : FL
Zip : 33461-3694
Country : US
Telephone Number : 561-964-0191
Fax Number : 561-968-9945
Provider Business Practice Location Address
First Line : 3230 LAKE WORTH RD
Second Line :
City : PALM SPRINGS
State : FL
Zip : 33461-3694
Country : US
Telephone Number : 561-964-0910
Fax Number : 561-968-9945
Authorized Official
Title or Position : MANAGING DIRECTOR
Name : MR. RAVI PATEL
Credential :
Telephone Number : 561-795-9845
Provider Enumeration Date : 09/25/2012
Last Update Date : 09/25/2012

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