MEDICARE: DR. OFELIA MADRID BERNABE 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	33055	MO

General Provider Information

NPI Number	:	1629338918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OFELIA MADRID BERNABE M.D.

Provider Business Mailing Address
First Line	:	7066 TWIN HILLS TER
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-2401
Country	:	US
Telephone Number	:	941-907-8294
Fax Number	:	941-907-8284

Provider Business Practice Location Address
First Line	:	7066 TWIN HILLS TER
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-2401
Country	:	US
Telephone Number	:	941-907-8294
Fax Number	:	941-907-8284

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

Provider Enumeration Date	:	05/21/2012
Last Update Date	:	05/21/2012

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