MEDICARE: DR. RUDOLPH EBERWEIN 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	ME85712	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821182791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUDOLPH EBERWEIN M.D.

Provider Business Mailing Address
First Line	:	11760 SW 40TH ST STE 112
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3589
Country	:	US
Telephone Number	:	305-485-7979
Fax Number	:	305-552-6969

Provider Business Practice Location Address
First Line	:	11760 SW 40TH ST STE 112
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3589
Country	:	US
Telephone Number	:	305-485-7979
Fax Number	:	305-552-6775

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	10/13/2008

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