=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427073253
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TODD A RELKIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 03/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 E SAMPLE RD 203
-----------------------------------------------------
City | LIGHTHOUSE POINT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-941-5282
-----------------------------------------------------
Fax | 954-941-5380
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 E SAMPLE RD 203
-----------------------------------------------------
City | LIGHTHOUSE POINT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-362-9321
-----------------------------------------------------
Fax | 954-941-5282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | M56341
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------