Provider Demographics
NPI:1821220823
Name:YORAM PADEH, M.D., P.A.
Entity Type:Organization
Organization Name:YORAM PADEH, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YORAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-866-7500
Mailing Address - Street 1:9445 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2803
Mailing Address - Country:US
Mailing Address - Phone:305-866-7500
Mailing Address - Fax:305-864-1896
Practice Address - Street 1:9445 HARDING AVE
Practice Address - Street 2:
Practice Address - City:SURFSIDE
Practice Address - State:FL
Practice Address - Zip Code:33154-2803
Practice Address - Country:US
Practice Address - Phone:305-866-7500
Practice Address - Fax:305-864-1896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82333207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272449900Medicaid
FLI38009Medicare UPIN
FL272449900Medicaid