MEDICARE: DAVID PORUDOMINSKY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	ME0045569	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	002661	OTHER	FL	NEIGHBORHOOD
3	61413	OTHER	FL	BLUE CROSS BLUE SHIELD
4	008272	OTHER	FL	AVMED
5	0163188	OTHER	FL	GHI

General Provider Information

NPI Number	:	1013993500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID PORUDOMINSKY MD

Provider Business Mailing Address
First Line	:	2901 CORAL HILLS DR STE 370
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4146
Country	:	US
Telephone Number	:	954-975-0350
Fax Number	:	954-975-3465

Provider Business Practice Location Address
First Line	:	2901 CORAL HILLS DR STE 370
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4146
Country	:	US
Telephone Number	:	954-975-0350
Fax Number	:	954-975-3465

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	11/14/2025

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Directions to “ DAVID PORUDOMINSKY MD” Practice Location

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