Provider Demographics
NPI:1356320808
Name:BANDEL, GERALDO (MD)
Entity Type:Individual
Prefix:
First Name:GERALDO
Middle Name:
Last Name:BANDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 W 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3222
Mailing Address - Country:US
Mailing Address - Phone:305-558-2500
Mailing Address - Fax:305-826-9002
Practice Address - Street 1:1475 W 49TH ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3222
Practice Address - Country:US
Practice Address - Phone:305-558-2500
Practice Address - Fax:305-826-9002
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0079654207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06577OtherBCBS
FL268828000Medicaid
FL06577OtherBCBS
FLE4507BMedicare ID - Type Unspecified