Organization
ORTHOPEDIC SURGERY AND SPORTS MED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE CAVANAUGH (BILLING MANAGER)
(386) 274-5712
Entity
Organization
Contact information
Practice address
1275 W GRANADA BLVD, SUITE 3B, ORMOND BEACH, FL 32174-8259
(386) 672-7850
Mailing address
1275 W GRANADA BLVD, SUITE 3B, ORMOND BEACH, FL 32174-8259
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
ME53344
FL
Other
Enumeration date
05/24/2007
Last updated
09/10/2007
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