Provider Demographics
NPI:1306942602
Name:SYNOVATION MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:SYNOVATION MEDICAL GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER-MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:VARGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-428-7733
Mailing Address - Street 1:PO BOX 12949
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33101-2949
Mailing Address - Country:US
Mailing Address - Phone:954-457-0064
Mailing Address - Fax:855-490-4044
Practice Address - Street 1:7000 SW 62ND AVE STE 535
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4724
Practice Address - Country:US
Practice Address - Phone:786-268-4044
Practice Address - Fax:866-206-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty