MEDICARE: SARIDAKIS SURGICAL ASSOCIATES PA

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	208600000X	Surgery Physician	ME83637	FL

General Provider Information

NPI Number	:	1700011913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARIDAKIS SURGICAL ASSOCIATES PA

Provider Business Mailing Address
First Line	:	5015 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6515
Country	:	US
Telephone Number	:	954-962-3225
Fax Number	:	954-962-7199

Provider Business Practice Location Address
First Line	:	5015 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6515
Country	:	US
Telephone Number	:	954-962-3225
Fax Number	:	954-962-7199

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ANGELEKE A SARIDAKIS
Credential	:	M.D.
Telephone Number	:	954-962-3225

Provider Enumeration Date	:	05/18/2009
Last Update Date	:	05/20/2009

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