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General NPI Number Information
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NPI Number | 1881869089
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Entity Type | Individual
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Provider Name | BASSEM M ELDAIF MD
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Gender | Male
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 07/29/2018
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Provider Practice Location Address
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Address Line | 6032 FARCENDA PL STE 102
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City | MELBOURNE
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State | FL
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Zip | 32940
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Country | US
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Telephone | 321-215-4799
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Fax | 321-252-4855
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Provider Business Mailing Address
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Address Line | 2085 HIGHWAY A1A APT 3301
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-1804
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Country | US
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Telephone | 954-294-1963
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Fax | 866-683-6309
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME101077
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License Number State | FL
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