Provider Demographics
NPI:1316483860
Name:SURGICAL PARTNERS OF SOUTH FLORIDA LLC.
Entity type:Organization
Organization Name:SURGICAL PARTNERS OF SOUTH FLORIDA LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/A.O./P.A.
Authorized Official - Prefix:
Authorized Official - First Name:LUCIANO
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:RADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-594-1527
Mailing Address - Street 1:PO BOX 970528
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33097-0528
Mailing Address - Country:US
Mailing Address - Phone:954-227-8224
Mailing Address - Fax:954-227-7442
Practice Address - Street 1:321 SE 8TH ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-8445
Practice Address - Country:US
Practice Address - Phone:954-594-1527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104117363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty