Provider Demographics
NPI:1265827968
Name:LEMUS, AVIEL OVADYAH (MD)
Entity Type:Individual
Prefix:
First Name:AVIEL
Middle Name:OVADYAH
Last Name:LEMUS
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 1:1100 S MIAMI AVE APT 2901
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4172
Mailing Address - Country:US
Mailing Address - Phone:305-925-7533
Mailing Address - Fax:305-925-7533
Practice Address - Street 1:1100 S MIAMI AVE APT 2901
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-4172
Practice Address - Country:US
Practice Address - Phone:305-925-7533
Practice Address - Fax:305-925-7533
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133583208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100654200Medicaid