Provider Demographics
NPI:1235168139
Name:LUPU, CORNEL J (MD)
Entity Type:Individual
Prefix:
First Name:CORNEL
Middle Name:J
Last Name:LUPU
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 1:4302 ALTON RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2891
Mailing Address - Country:US
Mailing Address - Phone:305-674-2665
Mailing Address - Fax:305-674-2659
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 600
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-674-2665
Practice Address - Fax:305-674-2659
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58893800Medicaid
FLD60195Medicare UPIN
FL92826WMedicare PIN