Provider Demographics
NPI:1881869089
Name:ELDAIF, BASSEM M (MD)
Entity type:Individual
Prefix:DR
First Name:BASSEM
Middle Name:M
Last Name:ELDAIF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2085 HIGHWAY A1A APT 3301
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-1804
Mailing Address - Country:US
Mailing Address - Phone:954-294-1963
Mailing Address - Fax:866-683-6309
Practice Address - Street 1:6032 FARCENDA PL STE 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-215-4799
Practice Address - Fax:321-252-4855
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME101077208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000314200Medicaid
FLME101077OtherFLORIDA MEDICAL LICENSE
FLAP953YMedicare PIN