Provider Demographics
NPI:1740236165
Name:CARMI Y STADLAN, M.D. P.A.
Entity type:Organization
Organization Name:CARMI Y STADLAN, M.D. P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMI
Authorized Official - Middle Name:Y
Authorized Official - Last Name:STADLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-969-3795
Mailing Address - Street 1:122A JFK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6606
Mailing Address - Country:US
Mailing Address - Phone:561-969-3795
Mailing Address - Fax:561-969-3771
Practice Address - Street 1:122A JFK DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-6606
Practice Address - Country:US
Practice Address - Phone:561-969-3795
Practice Address - Fax:561-969-3771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69654208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379642600Medicaid
FLQ0054OtherMEDICARE
FL379642600Medicaid