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NPI Code Detail

MEDICARE: INDEPENDENT SURGICAL GROUP LLC

MEDICARE: INDEPENDENT SURGICAL GROUP 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
12084B0002XObesity Medicine (Psychiatry & Neurology) Physician
2208600000XSurgery Physician
32086X0206XSurgical Oncology Physician

General Provider Information

NPI Number : 1194220962
Entity Type Code : Organization
Provider Name (Legal Business Name) : INDEPENDENT SURGICAL GROUP LLC
Provider Business Mailing Address
First Line : 3461 FAIRLANE FARMS RD
Second Line :
City : WELLINGTON
State : FL
Zip : 33414-8752
Country : US
Telephone Number : 561-766-1301
Fax Number : 561-693-0539
Provider Business Practice Location Address
First Line : 142 JOHN F KENNEDY DR
Second Line :
City : ATLANTIS
State : FL
Zip : 33462-1159
Country : US
Telephone Number : 561-439-1500
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. ARTHUR HANSEN
Credential : DPM
Telephone Number : 561-766-1301
Provider Enumeration Date : 03/26/2018
Last Update Date : 03/26/2018

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Directions to “INDEPENDENT SURGICAL GROUP LLC ” Practice Location

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