MEDICARE: SOUTH FLORIDA ENT ASSOCIATES HEARING, 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	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1356639454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA ENT ASSOCIATES HEARING, LLC

Provider Business Mailing Address
First Line	:	14750 NW 77TH CT
Second Line	:	SUITE 200
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-1507
Country	:	US
Telephone Number	:	305-558-3724
Fax Number	:	786-662-3669

Provider Business Practice Location Address
First Line	:	14750 NW 77TH CT
Second Line	:	SUITE 200
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-1507
Country	:	US
Telephone Number	:	305-558-3724
Fax Number	:	786-662-3669

Authorized Official
Title or Position	:	CEO
Name	:	STACEY CITRIN
Credential	:	MBA
Telephone Number	:	305-558-3724

Provider Enumeration Date	:	07/11/2011
Last Update Date	:	07/11/2011

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