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A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Vascular Surgery |
2086S0129X | 76 | Physician/Peripheral Vascular Disease |
| NPI Number | 1720630650 |
| LBN Legal business name | BROAD STREET PROFESSIONAL MEDICAL SERVICES LLC |
| Authorized official | AMI ALMEDA - (CREDENTIALING MANAGER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 07/11/2019 |
| Last updated | 07/11/2019 - About 7 years ago |
| Identifiers | n/a |
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BROAD STREET PROFESSIONAL MEDICAL SERVICES LLC
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BROAD STREET PROFESSIONAL MEDICAL SERVICES LLC