MEDICARE: IRA M LITZENBLATT 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	207RG0100X	Gastroenterology Physician	ME 36265	FL

General Provider Information

NPI Number	:	1942263876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRA M LITZENBLATT M.D.

Provider Business Mailing Address
First Line	:	4701 N FEDERAL HWY
Second Line	:	SUITE A-10
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4608
Country	:	US
Telephone Number	:	954-351-1100
Fax Number	:	954-351-1197

Provider Business Practice Location Address
First Line	:	4701 N FEDERAL HWY
Second Line	:	SUITE A-10
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4608
Country	:	US
Telephone Number	:	954-351-1100
Fax Number	:	954-351-1197

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/08/2007

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