MEDICARE: DR. CARMI Y STADLAN 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	174400000X	Specialist	ME69654	FL

General Provider Information

NPI Number	:	1396788451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARMI Y STADLAN MD

Provider Business Mailing Address
First Line	:	122A JFK DRIVE
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33463-6606
Country	:	US
Telephone Number	:	561-969-3795
Fax Number	:	561-969-3771

Provider Business Practice Location Address
First Line	:	122A JFK DR
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-6606
Country	:	US
Telephone Number	:	561-969-3795
Fax Number	:	561-969-3771

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/08/2007

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