Provider Demographics
NPI:1609983733
Name:PISKUR, MATHIAS (MD)
Entity Type:Individual
Prefix:
First Name:MATHIAS
Middle Name:
Last Name:PISKUR
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 1:1652 W HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1657
Mailing Address - Country:US
Mailing Address - Phone:954-428-3558
Mailing Address - Fax:954-428-5489
Practice Address - Street 1:1652 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1657
Practice Address - Country:US
Practice Address - Phone:954-428-3558
Practice Address - Fax:954-428-5489
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME28203207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79239Medicare ID - Type Unspecified
FLD58709Medicare UPIN