Provider Demographics
NPI:1487609855
Name:KOFMAN, EDUARDO A (MD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:A
Last Name:KOFMAN
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 1:12550 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2541
Mailing Address - Country:US
Mailing Address - Phone:305-892-3101
Mailing Address - Fax:305-892-3103
Practice Address - Street 1:12550 BISCAYNE BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2541
Practice Address - Country:US
Practice Address - Phone:305-892-3101
Practice Address - Fax:305-892-3103
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4109207RG0100X
FLME84340207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG59126Medicare UPIN
FLAL422ZMedicare PIN
TX0043CDMedicare PIN