Provider Demographics
NPI:1851389480
Name:DAVID M FELDBAUM MD PA
Entity Type:Organization
Organization Name:DAVID M FELDBAUM MD PA
Other - Org Name:VEIN & VASCULAR CENTER OF SOUTH FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FELDBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-964-6684
Mailing Address - Street 1:2205 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3611
Mailing Address - Country:US
Mailing Address - Phone:954-964-6684
Mailing Address - Fax:954-964-6649
Practice Address - Street 1:2205 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3611
Practice Address - Country:US
Practice Address - Phone:954-964-6684
Practice Address - Fax:954-964-6649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME793472086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4647Medicare ID - Type Unspecified