Provider Demographics
NPI:1194775759
Name:PALM BEACH NEUROSURGERY LLC
Entity type:Organization
Organization Name:PALM BEACH NEUROSURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR.
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO, PHD
Authorized Official - Phone:561-433-4444
Mailing Address - Street 1:4560 LANTANA RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6998
Mailing Address - Country:US
Mailing Address - Phone:561-433-4444
Mailing Address - Fax:561-433-8877
Practice Address - Street 1:4560 LANTANA RD STE 120
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6998
Practice Address - Country:US
Practice Address - Phone:561-433-4444
Practice Address - Fax:561-433-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277724000Medicaid
FLQ0287Medicare PIN