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1912991399

NPI Code Detail

MEDICARE: DR. EVELYN S BROIKOS MD

MEDICARE: DR. EVELYN S BROIKOS 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	207R00000X	Internal Medicine Physician	197121	NY

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	:	1912991399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVELYN S BROIKOS MD

Provider Business Mailing Address
First Line	:	2250 TURK HILL RD
Second Line	:
City	:	VICTOR
State	:	NY
Zip	:	14564
Country	:	US
Telephone Number	:	585-425-2820
Fax Number	:

Provider Business Practice Location Address
First Line	:	2066 HUDSON AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-4300
Country	:	US
Telephone Number	:	585-922-2800
Fax Number	:	585-922-2866

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/24/2009

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Directions to “ DR. EVELYN S BROIKOS MD” Practice Location

Language	Start Address	Practice Location

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