MEDICARE: DR. MAXIM CHUMAK 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	208600000X	Surgery Physician	4301093152	MI
2	207Q00000X	Family Medicine Physician	4301093152	MI
3	207Q00000X	Family Medicine Physician	ME114939	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	:	1942463054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAXIM CHUMAK M.D.

Provider Business Mailing Address
First Line	:	551 N FEDERAL HWY
Second Line	:	SUITE 800
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2559
Country	:	US
Telephone Number	:	832-623-2002
Fax Number	:	186-639-5218

Provider Business Practice Location Address
First Line	:	551 N FEDERAL HWY
Second Line	:	SUITE 800
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2559
Country	:	US
Telephone Number	:	832-623-2002
Fax Number	:	186-639-5218

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

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/15/2016

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