MEDICARE: WASFI A MAKAR 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	2085R0001X	Radiation Oncology Physician	ME0056764	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10141	OTHER	FL	BLUE SHIELD
2	950480	OTHER	FL	AETNA

General Provider Information

NPI Number	:	1386752418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WASFI A MAKAR MD

Provider Business Mailing Address
First Line	:	211 CORAL SANDS DR
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-2749
Country	:	US
Telephone Number	:	321-632-3400
Fax Number	:	321-632-1766

Provider Business Practice Location Address
First Line	:	211 CORAL SANDS DR
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-2749
Country	:	US
Telephone Number	:	321-632-3400
Fax Number	:	321-632-1766

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

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	07/08/2007

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