Provider Demographics
NPI:1194076653
Name:SFM UROLOGY I LLC
Entity type:Organization
Organization Name:SFM UROLOGY I LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-795-9845
Mailing Address - Street 1:3230 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3694
Mailing Address - Country:US
Mailing Address - Phone:561-964-0191
Mailing Address - Fax:561-968-9945
Practice Address - Street 1:3230 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3694
Practice Address - Country:US
Practice Address - Phone:561-964-0910
Practice Address - Fax:561-968-9945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH FLORIDA MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCL4658Medicare PIN