Provider Demographics
NPI:1003869918
Name:FEANNY, ELIAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:A
Last Name:FEANNY
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 1:9275 SW 152 ST
Mailing Address - Street 2:STE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157
Mailing Address - Country:US
Mailing Address - Phone:305-253-8869
Mailing Address - Fax:305-233-9726
Practice Address - Street 1:9275 SW 152 ST
Practice Address - Street 2:STE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157
Practice Address - Country:US
Practice Address - Phone:305-253-8869
Practice Address - Fax:305-233-9726
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255480100Medicaid
FL255480100Medicaid
44293Medicare ID - Type Unspecified