MEDICARE: DR. JUDITH A CHALYKOFF M.D.

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	207Q00000X	Family Medicine Physician	ME100974	ZZ

General Provider Information

NPI Number	:	1053304923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH A CHALYKOFF M.D.

Provider Business Mailing Address
First Line	:	10437 MOSS PARK RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32832-5812
Country	:	US
Telephone Number	:	407-802-1100
Fax Number	:	407-832-1101

Provider Business Practice Location Address
First Line	:	10437 MOSS PARK RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32832-5812
Country	:	US
Telephone Number	:	407-802-1100
Fax Number	:	407-832-1101

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	02/09/2012

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