Provider Demographics
NPI:1528011228
Name:SOUTH FLORIDA INFECTIOUS DISEASES PA
Entity Type:Organization
Organization Name:SOUTH FLORIDA INFECTIOUS DISEASES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-381-3443
Mailing Address - Street 1:16244 MILITARY TRL
Mailing Address - Street 2:SUITE 750
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6534
Mailing Address - Country:US
Mailing Address - Phone:561-381-3443
Mailing Address - Fax:561-381-3441
Practice Address - Street 1:16244 MILITARY TRL
Practice Address - Street 2:SUITE 750
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6534
Practice Address - Country:US
Practice Address - Phone:561-381-3443
Practice Address - Fax:561-381-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75788207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00336029OtherRAILROAD MEDICARE
FLK9939Medicare PIN