Provider Demographics
NPI:1265628861
Name:ALLAN BIRNBAUM DO PA
Entity Type:Organization
Organization Name:ALLAN BIRNBAUM DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:FOLLMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-337-7320
Mailing Address - Street 1:1701 SE HILLMOOR DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7552
Mailing Address - Country:US
Mailing Address - Phone:772-337-7320
Mailing Address - Fax:772-337-7321
Practice Address - Street 1:1701 SE HILLMOOR DR
Practice Address - Street 2:SUITE 5
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7552
Practice Address - Country:US
Practice Address - Phone:772-337-7320
Practice Address - Fax:772-337-7321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4258207R00000X
FLME124391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33699Medicare PIN