Healthcare Provider Details

I. General information

NPI: 1487609855
Provider Name (Legal Business Name): EDUARDO A KOFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12550 BISCAYNE BLVD SUITE 600
NORTH MIAMI FL
33181-2541
US

IV. Provider business mailing address

12550 BISCAYNE BLVD SUITE 600
NORTH MIAMI FL
33181-2541
US

V. Phone/Fax

Practice location:
  • Phone: 305-892-3101
  • Fax: 305-892-3103
Mailing address:
  • Phone: 305-892-3101
  • Fax: 305-892-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberK4109
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME84340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: