Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME84422 | FL |
Y | 208600000X | Surgeon | ME84422 | FL |
N | 2086S0129X | Vascular Surgeon | ME84422 | FL |
NPI | 1043205404 |
---|---|
Provider Name | Dr. Christian L Birkedal |
First Address | Daytona Beach, FL 32117-5168 |
Second Address | Daytona Beach, FL 32117-5168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 10/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
263857600 | (05) | FL |
H61029 | (02) | FL |