Provider Demographics
NPI:1326081530
Name:ARDEL, BRIAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:ARDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3417D TAMIAMI TRAIL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952
Mailing Address - Country:US
Mailing Address - Phone:941-627-3882
Mailing Address - Fax:941-627-3290
Practice Address - Street 1:3417D TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-627-3882
Practice Address - Fax:941-627-3290
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0050259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03678ZMedicare PIN