MEDICARE: PHYLLIS NEIMARK 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	2086X0206X	Surgical Oncology Physician	51811	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1598750408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS NEIMARK MD

Provider Business Mailing Address
First Line	:	PO BOX 862233
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32886-2233
Country	:	US
Telephone Number	:	954-985-5846
Fax Number	:	954-985-2451

Provider Business Practice Location Address
First Line	:	1150 N 35TH AVE
Second Line	:	SUITE-495
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-5424
Country	:	US
Telephone Number	:	954-265-5846
Fax Number	:	954-985-2451

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	03/22/2013

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