Provider Demographics
NPI:1730852708
Name:ATISSO MEDICAL CENTER
Entity type:Organization
Organization Name:ATISSO MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANTZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINVIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:954-290-9159
Mailing Address - Street 1:2331 N STATE ROAD 7 STE 220
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3772
Mailing Address - Country:US
Mailing Address - Phone:954-290-9159
Mailing Address - Fax:954-206-0561
Practice Address - Street 1:2331 N STATE ROAD 7 STE 220
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-3772
Practice Address - Country:US
Practice Address - Phone:954-290-9159
Practice Address - Fax:954-206-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty