ROMAN B. KLOS MD,PA
Radiology at 20 Ter, Fort Lauderdale, FL

License number
Florida ME 62266
Category
Radiology
Type
Thoracic Surgery (Cardiothoracic Vascular Surgery)
Owner
Name: DR. ROMAN B KLOS MD
Title: PRESIDENT
Phone: (954) 776-9899
Address
Address
4800 NE 20Th Ter STE 101, Fort Lauderdale, FL 33308
National Provider ID: 1083967517
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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ROMAN B. KLOS, M.D., PA

4800 NE 20 Ter SUITE 101, Fort Lauderdale, FL 33308

Status:
Inactive
Inactive reason:
ADMIN DISSOLUTION FOR ANNUAL REPORT
Registration:
Oct 18, 1996
Inactive since:
Sep 25, 2009
State ID:
P96000086540
Business type:
Florida Profit Corporation
President, Treasurer, Secretary, Director:
Roman B Klos President, Treasurer, Secretary, Director, inactive, 4800 NE 20 Ter SUITE 101, Fort Lauderdale, FL 33308 (Physical)
Agent:
Roman Klos,4800 NE 20 Ter SUITE 101, Fort Lauderdale, FL 33308 (Physical)
EIN:
65-0694007
Categories:
General Surgeons, Physicians & Surgeons

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