Provider Demographics
NPI:1821182791
Name:EBERWEIN, RUDOLPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:
Last Name:EBERWEIN
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 1:11760 SW 40TH ST STE 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3589
Mailing Address - Country:US
Mailing Address - Phone:305-485-7979
Mailing Address - Fax:305-552-6969
Practice Address - Street 1:11760 SW 40TH ST STE 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3589
Practice Address - Country:US
Practice Address - Phone:305-485-7979
Practice Address - Fax:305-552-6775
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265109200Medicaid
FL265109200Medicaid
FLH47878Medicare UPIN