Provider Demographics
NPI:1649306820
Name:BACKMAN, KARL ERIC (MD)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:ERIC
Last Name:BACKMAN
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 1:4740 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5839
Mailing Address - Country:US
Mailing Address - Phone:954-486-4005
Mailing Address - Fax:954-497-3857
Practice Address - Street 1:3440 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2000
Practice Address - Country:US
Practice Address - Phone:954-424-6911
Practice Address - Fax:954-497-3857
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76676174400000X
FLME700652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254610800Medicaid
FLG77051Medicare UPIN
FL254610800Medicaid