MEDICARE: ADVANCED GENERAL SURGERY PA

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	208600000X	Surgery 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	:	1841232568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED GENERAL SURGERY PA

Provider Business Mailing Address
First Line	:	983 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-7048
Country	:	US
Telephone Number	:	954-227-2030
Fax Number	:	954-227-2010

Provider Business Practice Location Address
First Line	:	983 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-7048
Country	:	US
Telephone Number	:	954-227-2030
Fax Number	:	954-227-2010

Authorized Official
Title or Position	:	PRESIDENT
Name	:	INDREK MIIDLA
Credential	:	M.D.
Telephone Number	:	954-227-2030

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	09/12/2008

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Directions to “ADVANCED GENERAL SURGERY PA ” Practice Location

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