MEDICARE: UNIVERSITY CANCER INSTITUTE 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	174400000X	Specialist	ME80006	FL

General Provider Information

NPI Number	:	1821028606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY CANCER INSTITUTE LLC

Provider Business Mailing Address
First Line	:	2240 W WOOLBRIGHT ROAD
Second Line	:	SUITE 415
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-6367
Country	:	US
Telephone Number	:	561-737-6556
Fax Number	:	561-737-2662

Provider Business Practice Location Address
First Line	:	2240 W WOOLBRIGHT ROAD
Second Line	:	SUITE 415
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-6367
Country	:	US
Telephone Number	:	561-737-6556
Fax Number	:	561-737-2662

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. THOMAS MJ NIEDERMAN
Credential	:	M.D.
Telephone Number	:	561-737-6556

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	01/31/2013

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