MEDICARE: DR. MOISES SIPERSTEIN-BLUMOVICZ 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	207R00000X	Internal Medicine Physician	ME-76469	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04845160	OTHER		ECFMG NUMBER

General Provider Information

NPI Number	:	1568436103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOISES SIPERSTEIN-BLUMOVICZ M.D.

Provider Business Mailing Address
First Line	:	10377 S US HIGHWAY 1
Second Line	:	SUITE 102
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5630
Country	:	US
Telephone Number	:	772-337-7811
Fax Number	:	772-337-7833

Provider Business Practice Location Address
First Line	:	10377 S US HIGHWAY 1
Second Line	:	SUITE 102
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5630
Country	:	US
Telephone Number	:	772-337-7811
Fax Number	:	772-337-7833

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	03/23/2015

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