MEDICARE: UNIVERSITY MEDICAL, INC.

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	208D00000X	General Practice Physician	ME63889	FL

General Provider Information

NPI Number	:	1205074150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY MEDICAL, INC.

Provider Business Mailing Address
First Line	:	233 N UNIVERSITY DR
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6715
Country	:	US
Telephone Number	:	954-983-1119
Fax Number	:	954-983-1929

Provider Business Practice Location Address
First Line	:	233 N UNIVERSITY DR
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6715
Country	:	US
Telephone Number	:	954-983-1119
Fax Number	:	954-983-1929

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID HIRSCHENSON
Credential	:	D.C.
Telephone Number	:	954-983-1119

Provider Enumeration Date	:	01/30/2009
Last Update Date	:	10/21/2009

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