Provider Demographics
NPI:1336144229
Name:EDELMAN, DAVID S (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:EDELMAN
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 1:10125 SW 71ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3233
Mailing Address - Country:US
Mailing Address - Phone:305-666-1657
Mailing Address - Fax:305-271-7663
Practice Address - Street 1:6401 SW 87TH AVE
Practice Address - Street 2:STE 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2500
Practice Address - Country:US
Practice Address - Phone:305-271-4080
Practice Address - Fax:305-271-7663
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL43059208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03762Medicare ID - Type Unspecified
FLD208042Medicare UPIN