Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | ME 45714 | FL |
NPI | 1033153952 |
---|---|
Provider Name | Milton Gedallovich |
First Address | Pembroke Pines, FL 33028-1023 |
Second Address | Pembroke Pines, FL 33028-1023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D79578 | (02) | FL |