MEDICARE: DR. DOV I EIDELMAN 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	208200000X	Plastic Surgery Physician	ME77989	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558344424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOV I EIDELMAN MD

Provider Business Mailing Address
First Line	:	4700 N CONGRESS AVE SUITE 103
Second Line	:	STE 100
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407
Country	:	US
Telephone Number	:	561-968-7111
Fax Number	:	561-968-1800

Provider Business Practice Location Address
First Line	:	4700 N CONGRESS AVE SUITE 103
Second Line	:	STE 100
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407
Country	:	US
Telephone Number	:	561-968-7111
Fax Number	:	561-968-1800

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	07/03/2023

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