MEDICARE: GENESISCARE USA OF 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	:	1770952616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESISCARE USA OF FLORIDA LLC

Provider Business Mailing Address
First Line	:	1419 SE 8TH TER STE 200
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3213
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	293-931-7385

Provider Business Practice Location Address
First Line	:	3361 SOUTH MIAMI AVENUE
Second Line	:	SUITE 306
City	:	MIAMI
State	:	FL
Zip	:	33133-4232
Country	:	US
Telephone Number	:	305-856-5057
Fax Number	:	305-856-8735

Authorized Official
Title or Position	:	CFO
Name	:	IAN WONG
Credential	:
Telephone Number	:	303-249-7486

Provider Enumeration Date	:	09/22/2015
Last Update Date	:	11/03/2025

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Directions to “GENESISCARE USA OF FLORIDA LLC ” Practice Location

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