MEDICARE: DR. DANIEL RIVLIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	ME54696	FL
2	207ND0900X	Dermatopathology Physician	ME54696	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073518692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL RIVLIN MD

Provider Business Mailing Address
First Line	:	4308 ALTON RD
Second Line	:	STE 510
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2840
Country	:	US
Telephone Number	:	305-674-8865
Fax Number	:	305-674-1459

Provider Business Practice Location Address
First Line	:	4308 ALTON RD
Second Line	:	STE 510
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2840
Country	:	US
Telephone Number	:	305-674-8865
Fax Number	:	305-674-1459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	11/04/2008

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