MEDICARE: LIDIA BOJORGE

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	2255A2300X	Athletic Trainer	AL3608	FL

General Provider Information

NPI Number	:	1235547753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIDIA BOJORGE

Provider Business Mailing Address
First Line	:	2307 W BROWARD BLVD
Second Line	:	STE 200
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-1417
Country	:	US
Telephone Number	:	954-792-1010
Fax Number	:	954-792-1199

Provider Business Practice Location Address
First Line	:	1601 S ANDREWS AVE FL 2
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2509
Country	:	US
Telephone Number	:	954-764-2192
Fax Number	:

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

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	03/22/2017

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Directions to “ LIDIA BOJORGE ” Practice Location

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