MEDICARE: DR. DAVID MAFDALI 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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO1083	FL

General Provider Information

NPI Number	:	1427041300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID MAFDALI D.P.M.

Provider Business Mailing Address
First Line	:	1379 HARBORVIEW EAST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-5054
Country	:	US
Telephone Number	:	954-362-4779
Fax Number	:	954-362-4779

Provider Business Practice Location Address
First Line	:	1379 HARBORVIEW EAST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-5054
Country	:	US
Telephone Number	:	954-362-4779
Fax Number	:	954-362-4779

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	09/20/2012

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