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	208C00000X	Colon & Rectal Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	CE7138	OTHER	FL	RAILROAD MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881639482
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	:	239-931-7385

Provider Business Practice Location Address
First Line	:	13770 PLANTATION RD STE 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4460
Country	:	US
Telephone Number	:	239-275-0728
Fax Number	:	293-275-6947

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHADEN MARZOUK
Credential	:
Telephone Number	:	239-931-7254

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	10/05/2023

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Directions to “GENESISCARE USA OF FLORIDA LLC ” Practice Location

Language	Start Address	Practice Location

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