Organization
GENESISCARE USA OF FLORIDA LLC
Active
Parent organization
GENESISCARE USA INC
Other names
The Colorectal Institute
Organization subpart
Yes
Provider details
NPI number
Legal business name
GENESISCARE USA INC
Authorized official
SHADEN MARZOUK (PRESIDENT)
(239) 931-7254
Entity
Organization
Contact information
Practice address
13770 PLANTATION RD STE 2, FORT MYERS, FL 33912-4460
(239) 275-0728
(293) 275-6947
Mailing address
1419 SE 8TH TER STE 200, CAPE CORAL, FL 33990-3213
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060239634
—
FL
05
—
060239635
—
FL
05
—
060239645
—
FL
01
—
CE7138
RAILROAD MEDICARE
FL
Enumeration date
06/18/2006
Last updated
10/05/2023
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