Provider Demographics
NPI:1629200209
Name:ELIAS M HERSCHMANN MD PA
Entity Type:Organization
Organization Name:ELIAS M HERSCHMANN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERSCHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-534-8211
Mailing Address - Street 1:4430 PINE TREE DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3132
Mailing Address - Country:US
Mailing Address - Phone:305-491-2233
Mailing Address - Fax:305-531-7784
Practice Address - Street 1:4430 PINE TREE DR
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3132
Practice Address - Country:US
Practice Address - Phone:305-491-2233
Practice Address - Fax:305-531-7784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0015129207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91066Medicare PIN
FLD59486Medicare UPIN