Provider Demographics
NPI:1134290539
Name:MUALIN, ELIAS JOSE (MD)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:JOSE
Last Name:MUALIN
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 1:450 N PARK RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5403
Mailing Address - Country:US
Mailing Address - Phone:954-983-2101
Mailing Address - Fax:954-983-2860
Practice Address - Street 1:450 N PARK RD
Practice Address - Street 2:SUITE 202
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5403
Practice Address - Country:US
Practice Address - Phone:954-983-2101
Practice Address - Fax:954-983-2860
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86605207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291529OtherAVMED
FL0845933OtherPARITY HEALTHCARE
FL266415101Medicaid
FL300151000OtherTRICARE
FL29130OtherBCBS
FL994795OtherNHP
FL266415101Medicaid
FL29130ZMedicare PIN
FL300151000OtherTRICARE