Healthcare Provider Details

I. General information

NPI: 1750027173
Provider Name (Legal Business Name): EDWIN JAMES MAKAREVICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

5201 W SAXON CIR
SOUTHWEST RANCHES FL
33331-2800
US

V. Phone/Fax

Practice location:
  • Phone: 954-459-2094
  • Fax:
Mailing address:
  • Phone: 954-770-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: