Provider Demographics
NPI:1134128481
Name:COSTANTINI, EUGENE NORMAN (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:NORMAN
Last Name:COSTANTINI
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 1:1777 S ANDREWS AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2517
Mailing Address - Country:US
Mailing Address - Phone:954-462-4413
Mailing Address - Fax:954-462-5413
Practice Address - Street 1:1777 S ANDREWS AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2517
Practice Address - Country:US
Practice Address - Phone:954-462-4413
Practice Address - Fax:954-462-5413
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57582208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063842100Medicaid
FL063842100Medicaid
FL10878Medicare ID - Type Unspecified