Provider Demographics
NPI:1538369962
Name:KELIJMAN, MIRTHA (MD)
Entity type:Individual
Prefix:
First Name:MIRTHA
Middle Name:
Last Name:KELIJMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 GLADES RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6461
Mailing Address - Country:US
Mailing Address - Phone:561-367-8202
Mailing Address - Fax:561-367-8257
Practice Address - Street 1:670 GLADES RD
Practice Address - Street 2:SUITE 310
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6461
Practice Address - Country:US
Practice Address - Phone:561-367-8202
Practice Address - Fax:561-367-8257
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 67985207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH525OtherAVMED
FL0007582454OtherAETNA
FL44842OtherBLUE CROSS BLUE SHIELD OF FLA
FLP00064212OtherRAILROAD MEDICARE
FL0005123136OtherAETNA
FL0007582454OtherAETNA