Provider Demographics
NPI:1659337517
Name:SOUTH COUNTY ENDOCRINOLOGY P A
Entity Type:Organization
Organization Name:SOUTH COUNTY ENDOCRINOLOGY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELIJMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-367-8202
Mailing Address - Street 1:670 GLADES RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6461
Mailing Address - Country:US
Mailing Address - Phone:561-367-8202
Mailing Address - Fax:561-367-8257
Practice Address - Street 1:670 GLADES RD
Practice Address - Street 2:SUITE 310
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6461
Practice Address - Country:US
Practice Address - Phone:561-367-8202
Practice Address - Fax:561-367-8257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 67985207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252927OtherAVMED
FL44842OtherBLUE CROSS BLUE SHIELD OF FLA
FLP00064212OtherRAILROAD MEDICARE
FLFP0935OtherHEALTHNET
FL44842OtherBLUE CROSS BLUE SHIELD OF FLA
FLP00064212OtherRAILROAD MEDICARE