MEDICARE: ILIYA BEYLIN D.P.M.

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	213E00000X	Podiatrist	PO2983	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480034620	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	65741	OTHER	FL	BLUE CROSS BLUE SHIELD
3	2700759	OTHER	FL	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1104803618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILIYA BEYLIN D.P.M.

Provider Business Mailing Address
First Line	:	7501 WILES RD
Second Line	:	SUITE 104
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2063
Country	:	US
Telephone Number	:	954-755-4994
Fax Number	:	954-755-4995

Provider Business Practice Location Address
First Line	:	7501 WILES RD
Second Line	:	SUITE 104
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2063
Country	:	US
Telephone Number	:	954-755-4994
Fax Number	:	954-755-4995

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	11/18/2010

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