Provider Demographics
NPI:1154333987
Name:LUGO, ALEXIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:LUGO
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 1:9703 S DIXIE HWY
Mailing Address - Street 2:STE # 17
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-8114
Mailing Address - Country:US
Mailing Address - Phone:305-281-2813
Mailing Address - Fax:305-238-5171
Practice Address - Street 1:9703 S DIXIE HWY
Practice Address - Street 2:STE # 17
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-8114
Practice Address - Country:US
Practice Address - Phone:305-281-2813
Practice Address - Fax:305-238-5171
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277405400Medicaid
FL277405400Medicaid