Organization
GENESISCARE USA OF FLORIDA LLC
Active
Parent organization
GENESISCARE USA INC
Other names
Lawrence R. Black, DO
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
13691 METRO PKWY STE 350, METRO MEDICAL PLAZA, FORT MYERS, FL 33912-4351
(239) 768-5313
(239) 768-9559
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
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CE7138
RAILROAD MEDICARE
FL
Enumeration date
03/15/2013
Last updated
09/28/2023
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