Healthcare Provider Details

I. General information

NPI: 1689663973
Provider Name (Legal Business Name): NEIL FIDEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 GLADES RD SUITE 300
BOCA RATON FL
33431-6461
US

IV. Provider business mailing address

670 GLADES RD SUITE 300
BOCA RATON FL
33431-6461
US

V. Phone/Fax

Practice location:
  • Phone: 561-417-3732
  • Fax: 561-393-8464
Mailing address:
  • Phone: 561-417-3732
  • Fax: 561-393-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME90763
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: