MEDICARE: FLORIDA MAT PHYSICIANS, 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
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1265959357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA MAT PHYSICIANS, LLC

Provider Business Mailing Address
First Line	:	3113 STIRLING RD STE 103
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6547
Country	:	US
Telephone Number	:	954-995-3805
Fax Number	:

Provider Business Practice Location Address
First Line	:	3113 STIRLING RD STE 103
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6547
Country	:	US
Telephone Number	:	954-995-3805
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SAMUEL ROGATINSKY
Credential	:
Telephone Number	:	954-995-3805

Provider Enumeration Date	:	08/29/2017
Last Update Date	:	07/21/2022

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