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NPI Code Detail

MEDICARE: DR. JORDAN DITCHEK M.D.

MEDICARE: DR. JORDAN DITCHEK 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
12085B0100XBody Imaging PhysicianME81781FL
22085R0202XDiagnostic Radiology PhysicianME81781FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
105109OTHERFLBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063415248
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JORDAN DITCHEK M.D.
Provider Business Mailing Address
First Line : 500 N HIATUS RD STE 200
Second Line :
City : PEMBROKE PINES
State : FL
Zip : 33026-5213
Country : US
Telephone Number : 954-437-4800
Fax Number : 954-437-6628
Provider Business Practice Location Address
First Line : 3501 JOHNSON ST
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33021-5421
Country : US
Telephone Number : 954-987-2000
Fax Number : 954-437-6628
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 12/16/2021

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