Provider Demographics
NPI:1194788026
Name:SASSANI, RUSSELL FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:FRANK
Last Name:SASSANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4161 NW 5TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317
Mailing Address - Country:US
Mailing Address - Phone:954-585-3800
Mailing Address - Fax:954-585-6100
Practice Address - Street 1:4161 NW 5TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:954-585-3800
Practice Address - Fax:954-585-6100
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0066612208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25956YMedicare ID - Type Unspecified
F89993Medicare UPIN