MEDICARE: ORTHO 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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician

General Provider Information

NPI Number	:	1801429022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHO FLORIDA, LLC

Provider Business Mailing Address
First Line	:	751 PARK OF COMMERCE DR STE 112
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-3622
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2122 W CYPRESS CREEK RD STE 202
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-1858
Country	:	US
Telephone Number	:	954-816-3108
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	ADRIANA WEICHT
Credential	:
Telephone Number	:	561-300-1792

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/17/2020

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Directions to “ORTHO FLORIDA, LLC ” Practice Location

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