MEDICARE: MALCOLM EISELMAN 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	ME19629	FL

General Provider Information

NPI Number	:	1588984363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALCOLM EISELMAN M.D.

Provider Business Mailing Address
First Line	:	3650 N. 55TH AVENUE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2344
Country	:	US
Telephone Number	:	954-961-2034
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 N. 55TH AVENUE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2344
Country	:	US
Telephone Number	:	954-961-2034
Fax Number	:

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

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	06/03/2010

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