Provider Demographics
NPI:1720381130
Name:MATTHEW J EDLUND MD PA
Entity Type:Organization
Organization Name:MATTHEW J EDLUND MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:EDLUND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-365-4308
Mailing Address - Street 1:950 S TAMIAMI TRAIL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-7840
Mailing Address - Country:US
Mailing Address - Phone:941-365-4308
Mailing Address - Fax:941-366-1199
Practice Address - Street 1:950 S TAMIAMI TRAIL
Practice Address - Street 2:SUITE 100
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7840
Practice Address - Country:US
Practice Address - Phone:941-365-4308
Practice Address - Fax:941-366-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB22462Medicare UPIN