MEDICARE: DR. MICHAEL J FEDERMAN 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
1	207R00000X	Internal Medicine Physician	ME0096855	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110246814	OTHER	MI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06326051	OTHER	MI	BCBS INDIVIDUAL
3	78377	OTHER	FL	BCBS INDIVIDUAL
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	129451	OTHER	MI	CARE-PREFERRED CHOICES

General Provider Information

NPI Number	:	1295719912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J FEDERMAN M.D.

Provider Business Mailing Address
First Line	:	1500 NW 12TH AVE
Second Line	:	JMT-EAST 1007
City	:	MIAMI
State	:	FL
Zip	:	33136-1051
Country	:	US
Telephone Number	:	305-243-4664
Fax Number	:	305-243-9927

Provider Business Practice Location Address
First Line	:	3401 PGA BLVD
Second Line	:	SUITE 400
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2823
Country	:	US
Telephone Number	:	561-219-1000
Fax Number	:	561-694-6019

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	01/31/2013

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Directions to “ DR. MICHAEL J FEDERMAN M.D.” Practice Location

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