Provider Demographics
NPI:1073848834
Name:CELOGE, MARIE YOLETTE (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:YOLETTE
Last Name:CELOGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:YOLETTE
Other - Last Name:ELIACIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1400 NW 107TH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2746
Mailing Address - Country:US
Mailing Address - Phone:305-534-0076
Mailing Address - Fax:305-631-2908
Practice Address - Street 1:12615 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4803
Practice Address - Country:US
Practice Address - Phone:305-534-0076
Practice Address - Fax:305-693-8191
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN 309208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001894100Medicaid
FL001894100Medicaid