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Provider Information for 1033315239



DR. GEORGIY VLADIMIROVICH BRUSOVANIK MD

Other Name: GOSHA BRUSOVANIK
Gender: MALE

Individual NPI: 1033315239

Calendar Last Updated: 2014-03-12

Details

Name Value
NPI 1033315239
Enumeration Date 2007-06-25
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 7100 W 20TH AVE SUIT 513
HIALEAH, FL 33016-1897
United States

Phone: 305-467-5678 | Fax: 305-821-6782
View Map External Link
Primary Practice Address 7100 W 20TH AVE SUIT 513
HIALEAH, FL 33016-1897
United States

Phone: 305-467-5678 | Fax: 305-821-6782
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207X00000X - Orthopaedic Surgery HI MDR-4545
Other Identifiers
Issuer State Number