MEDICARE: UROLOGY PROFESSIONALS OF SOUTH FLORIDA 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	208800000X	Urology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467118745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UROLOGY PROFESSIONALS OF SOUTH FLORIDA LLC

Provider Business Mailing Address
First Line	:	3700 WASHINGTON ST STE 104
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-8291
Country	:	US
Telephone Number	:	305-836-1090
Fax Number	:	305-836-1199

Provider Business Practice Location Address
First Line	:	3939 HOLLYWOOD BLVD STE 3A
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6736
Country	:	US
Telephone Number	:	954-961-7700
Fax Number	:

Authorized Official
Title or Position	:	MGMR
Name	:	MATTHEW KOBINA HASFORD
Credential	:	MD
Telephone Number	:	305-836-1090

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	11/11/2021

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