MEDICARE: BROWARD SPINE 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	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	:	1821219155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWARD SPINE INSTITUTE LLC

Provider Business Mailing Address
First Line	:	3702 WASHINGTON ST STE 100
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-8283
Country	:	US
Telephone Number	:	954-272-2225
Fax Number	:	954-272-0554

Provider Business Practice Location Address
First Line	:	3702 WASHINGTON ST STE 100
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-8283
Country	:	US
Telephone Number	:	954-272-2225
Fax Number	:	954-272-0554

Authorized Official
Title or Position	:	OWNER
Name	:	MARSHALL STAUBER
Credential	:	MD
Telephone Number	:	954-272-2225

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	03/16/2026

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Directions to “BROWARD SPINE INSTITUTE LLC ” Practice Location

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