Provider Demographics
NPI:1144473323
Name:ELLIOT M WORTZEL MD PA
Entity type:Organization
Organization Name:ELLIOT M WORTZEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:M
Authorized Official - Last Name:WORTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-473-5304
Mailing Address - Street 1:201 NW 82ND AVE
Mailing Address - Street 2:#305
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7808
Mailing Address - Country:US
Mailing Address - Phone:954-370-1053
Mailing Address - Fax:
Practice Address - Street 1:201 NW 82ND AVE
Practice Address - Street 2:#305
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7808
Practice Address - Country:US
Practice Address - Phone:954-370-1053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME22208207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100007820OtherRAILROAD MEDICARE
FL0351971Medicaid
FL100007820OtherRAILROAD MEDICARE