MEDICARE: EDGARDO B. PENABAD 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	208D00000X	General Practice Physician	ME65669	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

General Provider Information

NPI Number	:	1063512960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGARDO B. PENABAD MD

Provider Business Mailing Address
First Line	:	7590 NW 186TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2952
Country	:	US
Telephone Number	:	786-953-6293
Fax Number	:	786-953-6891

Provider Business Practice Location Address
First Line	:	7590 NW 186TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-2952
Country	:	US
Telephone Number	:	786-953-6293
Fax Number	:	786-953-6891

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	12/20/2023

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Directions to “ EDGARDO B. PENABAD MD” Practice Location

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