MEDICARE: DIVERSIFIED SPECIALTIES

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1508992777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSIFIED SPECIALTIES

Provider Business Mailing Address
First Line	:	8000 RON BEATTY BLVD
Second Line	:	SUITE A-3
City	:	MICCO
State	:	FL
Zip	:	32976-7474
Country	:	US
Telephone Number	:	772-664-3668
Fax Number	:	772-664-3343

Provider Business Practice Location Address
First Line	:	8000 RON BEATTY BLVD
Second Line	:	SUITE A-3
City	:	MICCO
State	:	FL
Zip	:	32976-7474
Country	:	US
Telephone Number	:	772-664-3668
Fax Number	:	772-664-3343

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRUCE MARTIN NIGRO
Credential	:	D.P.M.
Telephone Number	:	772-664-3668

Provider Enumeration Date	:	02/24/2007
Last Update Date	:	06/03/2008

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Directions to “DIVERSIFIED SPECIALTIES ” Practice Location

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