MEDICARE: DR. PAUL L YUDELMAN 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	207RG0100X	Gastroenterology Physician	ME0059823	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11927W	OTHER	FL	MEDICARE
2	K7665	OTHER	FL	MEDICARE GROUP
3	P00232932	OTHER	FL	RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1578555918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL L YUDELMAN MD

Provider Business Mailing Address
First Line	:	12318 MCGREGOR WOODS CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-2440
Country	:	US
Telephone Number	:	239-209-0669
Fax Number	:

Provider Business Practice Location Address
First Line	:	12318 MCGREGOR WOODS CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-2440
Country	:	US
Telephone Number	:	239-209-0669
Fax Number	:

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	01/03/2019

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