MEDICARE: JOHN PAUL VIDOLIN 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	207X00000X	Orthopaedic Surgery Physician	ME0068375	FL
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	ME0068375	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	27192Z	OTHER	FL	MEDICARE PROVIDER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27192	OTHER	FL	BCBS
3	3925180001	OTHER		PALMETTO GBA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427039569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN PAUL VIDOLIN MD

Provider Business Mailing Address
First Line	:	836 SUNSET LAKE BLVD
Second Line	:	SUITE 102
City	:	VENICE
State	:	FL
Zip	:	34292-7554
Country	:	US
Telephone Number	:	941-497-1771
Fax Number	:	941-497-1860

Provider Business Practice Location Address
First Line	:	836 SUNSET LAKE BLVD
Second Line	:	SUITE 102
City	:	VENICE
State	:	FL
Zip	:	34292-7554
Country	:	US
Telephone Number	:	941-497-1771
Fax Number	:	941-497-1860

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	11/16/2007

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Directions to “ JOHN PAUL VIDOLIN MD” Practice Location

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