MEDICARE: SUSAN E. KORTLANDER, PH.D., P.A.

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	103T00000X	Psychologist	PY7141	FL

General Provider Information

NPI Number	:	1417312323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN E. KORTLANDER, PH.D., P.A.

Provider Business Mailing Address
First Line	:	2450 HOLLYWOOD BLVD # 200
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 HOLLYWOOD BLVD # 200
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6619
Country	:	US
Telephone Number	:	305-675-9200
Fax Number	:	305-672-9500

Authorized Official
Title or Position	:	BILLING ADMINISTRATOR
Name	:	MISS MARIA CUEVAS
Credential	:
Telephone Number	:	305-675-9200

Provider Enumeration Date	:	12/18/2015
Last Update Date	:	12/18/2015

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