Healthcare Provider Details

I. General information

NPI: 1346581824
Provider Name (Legal Business Name): EDEMA SPECIALISTS OF SOUTH FLORIDA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 SE 2ND AVE APT 404
DEERFIELD BEACH FL
33441-5444
US

IV. Provider business mailing address

702 SE 2ND AVE APT 404
DEERFIELD BEACH FL
33441-5444
US

V. Phone/Fax

Practice location:
  • Phone: 954-907-0826
  • Fax: 561-300-2156
Mailing address:
  • Phone: 954-907-0826
  • Fax: 561-300-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License NumberOT5972
License Number StateFL

VIII. Authorized Official

Name: PATRICIA MAULDIN
Title or Position: OWNER
Credential:
Phone: 954-907-0826