Provider Demographics
NPI:1427073253
Name:RELKIN, TODD A (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
Last Name:RELKIN
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 1:2100 E SAMPLE RD
Mailing Address - Street 2:203
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33062
Mailing Address - Country:US
Mailing Address - Phone:561-362-9321
Mailing Address - Fax:954-941-5282
Practice Address - Street 1:2100 E SAMPLE RD
Practice Address - Street 2:203
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-941-5282
Practice Address - Fax:954-941-5380
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM56341174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE22647Medicare UPIN
FL08878XMedicare PIN