Provider Demographics
NPI:1578683298
Name:EDELSTEIN, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:EDELSTEIN
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:PO BOX 030548
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33303-0548
Mailing Address - Country:US
Mailing Address - Phone:954-781-6422
Mailing Address - Fax:
Practice Address - Street 1:7201 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2913
Practice Address - Country:US
Practice Address - Phone:954-781-6422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME220772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSG067359OtherVISTA HLTH PLAN PIN
FLV2224OtherBCBS FLORIDA PIN
FL202947OtherHEALTHEASE PIN
FL498OtherTOTAL HLTH CHOICE PIN
FLO084766OtherINTEGRATED HLTH PLAN PIN
FL00002536540 02OtherUNITED HLTHCR PIN
FL650849890DOtherHUMANA HLTHCR PIN
FL7726045OtherAETNA PIN
FL1021806OtherCAREPLUS HLTH PLAN PIN
FL214355OtherAMERIGROUP PIN
FL280077OtherAVMED PIN
FL1021806OtherCAREPLUS HLTH PLAN PIN
FLE4936Medicare ID - Type Unspecified