MEDICARE: DR. LINDA LEE CIVERCHIA 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	174400000X	Specialist	ME 39279	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME 39279	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1346582087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA LEE CIVERCHIA M.D.

Provider Business Mailing Address
First Line	:	333 LAS OLAS WAY APT 210
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2374
Country	:	US
Telephone Number	:	954-235-3220
Fax Number	:	954-523-5429

Provider Business Practice Location Address
First Line	:	333 LAS OLAS WAY 210
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2363
Country	:	US
Telephone Number	:	954-235-3220
Fax Number	:	954-523-5429

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

Provider Enumeration Date	:	03/20/2013
Last Update Date	:	05/10/2013

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