MEDICARE: FLORIDA SPINE SPECIALISTS 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	208VP0000X	Pain Medicine Physician
2	207XS0117X	Orthopaedic Surgery of the Spine 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	:	1700110483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA SPINE SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	6000 N FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-2226
Country	:	US
Telephone Number	:	954-771-2551
Fax Number	:	954-492-5266

Provider Business Practice Location Address
First Line	:	6000 NORTH FEDERAL HWY
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-1772
Country	:	US
Telephone Number	:	954-771-2551
Fax Number	:	954-492-5266

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KALMAN BLUMBERG
Credential	:	MD
Telephone Number	:	954-771-2551

Provider Enumeration Date	:	09/28/2009
Last Update Date	:	03/11/2011

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