Provider Demographics
NPI:1689663973
Name:FIDEL, NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:FIDEL
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 1:670 GLADES RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6461
Mailing Address - Country:US
Mailing Address - Phone:561-417-3732
Mailing Address - Fax:561-393-8464
Practice Address - Street 1:670 GLADES RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6461
Practice Address - Country:US
Practice Address - Phone:561-417-3732
Practice Address - Fax:561-393-8464
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90763174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3705Medicare ID - Type Unspecified
FLB17475Medicare UPIN