Provider Demographics
NPI:1710223805
Name:MELVYN G DRUCKER MDPA
Entity Type:Organization
Organization Name:MELVYN G DRUCKER MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVYN
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:DRUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-923-3000
Mailing Address - Street 1:19955 PORTO VITA WAY
Mailing Address - Street 2:APT. 2701
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3427
Mailing Address - Country:US
Mailing Address - Phone:305-932-7738
Mailing Address - Fax:305-932-9285
Practice Address - Street 1:20601 E DIXIE HWY
Practice Address - Street 2:SUITE 330
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1540
Practice Address - Country:US
Practice Address - Phone:786-923-3000
Practice Address - Fax:786-923-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12262261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD59326Medicare UPIN