MEDICARE: BAPTIST DIABETES ASSOCIATES, P.A.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME0014724	FL

General Provider Information

NPI Number	:	1790110492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAPTIST DIABETES ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	7867 N KENDALL DR
Second Line	:	SUITE 80
City	:	MIAMI
State	:	FL
Zip	:	33156-7742
Country	:	US
Telephone Number	:	305-595-8252
Fax Number	:	305-595-7958

Provider Business Practice Location Address
First Line	:	7867 N KENDALL DR
Second Line	:	SUITE 80
City	:	MIAMI
State	:	FL
Zip	:	33156-7742
Country	:	US
Telephone Number	:	305-595-8252
Fax Number	:	305-595-7958

Authorized Official
Title or Position	:	TREASURER
Name	:	DR. MARTIN ROTHBERG
Credential	:	M.D.
Telephone Number	:	305-613-8853

Provider Enumeration Date	:	09/12/2013
Last Update Date	:	09/12/2013

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