=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134313349
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EBERWEIN AND SPAULDING MEDICAL GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2007
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11760 SW 40TH ST STE 112
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-3589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-485-7979
-----------------------------------------------------
Fax | 305-485-3533
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11760 SW 40TH ST STE 112
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-3589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-485-7979
-----------------------------------------------------
Fax | 305-485-3533
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. RUDOLPH EBERWEIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 786-348-7314
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME83258
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------