Organization
MIVIP ANESTHESIA GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ISAAC VERBUKH (SOLE MBR)
(561) 392-3341
Entity
Organization
Contact information
Practice address
11801 SW 90TH ST, SUITE 202, MIAMI, FL 33186-2182
(305) 595-6850
Mailing address
398 CAMINO GARDENS BLVD, SUITE 102, BOCA RATON, FL 33432-5827
(561) 392-3341
(561) 392-3793
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L16000067973
DOCUMENT NUMBER
FL
Enumeration date
04/15/2016
Last updated
07/21/2022
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