Provider Demographics
NPI:1104803618
Name:BEYLIN, ILIYA (DPM)
Entity type:Individual
Prefix:
First Name:ILIYA
Middle Name:
Last Name:BEYLIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 WILES RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2063
Mailing Address - Country:US
Mailing Address - Phone:954-755-4994
Mailing Address - Fax:954-755-4995
Practice Address - Street 1:7501 WILES RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2063
Practice Address - Country:US
Practice Address - Phone:954-755-4994
Practice Address - Fax:954-755-4995
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2983213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480034620OtherRAILROAD MEDICARE
FL65741OtherBLUE CROSS BLUE SHIELD
FL2700759OtherUNITED HEALTHCARE
FLU90289Medicare UPIN
FL65741XMedicare ID - Type Unspecified
FL65741ZMedicare ID - Type Unspecified