MEDICARE: EVAN MEHLMAN PHD P.A.

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	103TC0700X	Clinical Psychologist	PY0007206	FL

General Provider Information

NPI Number	:	1326345448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVAN MEHLMAN PHD P.A.

Provider Business Mailing Address
First Line	:	1011 IVES DAIRY RD
Second Line	:	BLDG 2 SUITE 208
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-2536
Country	:	US
Telephone Number	:	305-653-0098
Fax Number	:	305-654-4412

Provider Business Practice Location Address
First Line	:	1011 IVES DAIRY RD
Second Line	:	BLDG 2 SUITE 208
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-2536
Country	:	US
Telephone Number	:	305-653-0098
Fax Number	:	305-654-4412

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EVAN ADAM MEHLMAN
Credential	:	PHD
Telephone Number	:	305-653-0098

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	02/25/2011

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