Provider Demographics
NPI:1235102476
Name:FERNANDES, HILAIRE LOUIS (MD)
Entity Type:Individual
Prefix:MR
First Name:HILAIRE
Middle Name:LOUIS
Last Name:FERNANDES
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 1:7050 NW 4TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317
Mailing Address - Country:US
Mailing Address - Phone:954-587-4112
Mailing Address - Fax:954-587-2401
Practice Address - Street 1:7050 NW 4TH ST
Practice Address - Street 2:STE 101
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:954-587-4112
Practice Address - Fax:954-587-2401
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME026907207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037575600Medicaid
D60519Medicare UPIN