Provider Demographics
NPI:1942741319
Name:RUDOLPH EBERWEIN, MD PA
Entity Type:Organization
Organization Name:RUDOLPH EBERWEIN, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERWEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-670-2131
Mailing Address - Street 1:8585 SUNSET DR
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3746
Mailing Address - Country:US
Mailing Address - Phone:305-670-2131
Mailing Address - Fax:305-670-2132
Practice Address - Street 1:8585 SUNSET DR
Practice Address - Street 2:SUITE 103A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3746
Practice Address - Country:US
Practice Address - Phone:305-670-2131
Practice Address - Fax:305-670-2132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265109200Medicaid
FLE85714Medicare PIN
FLH47878Medicare UPIN