Provider Demographics
NPI:1053366674
Name:TREASURE COAST SURGICAL GROUP
Entity type:Organization
Organization Name:TREASURE COAST SURGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KLEABIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-219-4026
Mailing Address - Street 1:2221 SE OCEAN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3341
Mailing Address - Country:US
Mailing Address - Phone:772-219-4026
Mailing Address - Fax:772-219-8207
Practice Address - Street 1:2221 SE OCEAN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3341
Practice Address - Country:US
Practice Address - Phone:772-219-4026
Practice Address - Fax:772-219-8207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty