Provider Demographics
NPI:1538437694
Name:SFM SURGERY V LLC
Entity type:Organization
Organization Name:SFM SURGERY V LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-795-9845
Mailing Address - Street 1:3343 STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8002
Mailing Address - Country:US
Mailing Address - Phone:561-496-3103
Mailing Address - Fax:561-496-8791
Practice Address - Street 1:142 JOHN F KENNEDY DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-1159
Practice Address - Country:US
Practice Address - Phone:561-439-1500
Practice Address - Fax:561-439-9902
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH FLORIDA MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-05
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCL4658Medicare PIN