Provider Demographics
NPI:1053988105
Name:MEDICUS MEDICI PLLC
Entity type:Organization
Organization Name:MEDICUS MEDICI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SANTORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-672-4240
Mailing Address - Street 1:5630 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6351
Mailing Address - Country:US
Mailing Address - Phone:757-672-4240
Mailing Address - Fax:
Practice Address - Street 1:5630 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6351
Practice Address - Country:US
Practice Address - Phone:757-672-4240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty