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NPI Code Detail

MEDICARE: ROSA ZIDELIS M.D.

MEDICARE:   ROSA  ZIDELIS  M.D.
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
1174400000XSpecialistME 15540FL

General Provider Information

NPI Number : 1134234040
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSA ZIDELIS M.D.
Provider Business Mailing Address
First Line : 311 N ORANGE ST
Second Line :
City : NEW SMYRNA BEACH
State : FL
Zip : 32168-6733
Country : US
Telephone Number : 386-416-1023
Fax Number : 386-416-1037
Provider Business Practice Location Address
First Line : 311 N ORANGE ST
Second Line :
City : NEW SMYRNA BEACH
State : FL
Zip : 32168-6733
Country : US
Telephone Number : 386-416-1023
Fax Number : 386-416-1037
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2006
Last Update Date : 07/08/2007

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Directions to “ ROSA ZIDELIS M.D.” Practice Location

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