Provider Demographics
NPI:1538358528
Name:MICROSURGERY INC.
Entity type:Organization
Organization Name:MICROSURGERY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:FLYNN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-368-5488
Mailing Address - Street 1:875 MEADOWS RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2349
Mailing Address - Country:US
Mailing Address - Phone:561-368-5488
Mailing Address - Fax:561-367-0145
Practice Address - Street 1:875 MEADOWS RD
Practice Address - Street 2:SUITE 311
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2349
Practice Address - Country:US
Practice Address - Phone:561-368-5488
Practice Address - Fax:561-367-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2009-06-04
Deactivation Date:2008-01-09
Deactivation Code:
Reactivation Date:2009-06-04
Provider Licenses
StateLicense IDTaxonomies
FLME34683207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50934Medicare UPIN