Provider Demographics
NPI:1275529067
Name:BIEN-AIME, TONY (MD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:BIEN-AIME
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 1:19503 NW 57TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4709
Mailing Address - Country:US
Mailing Address - Phone:305-621-8080
Mailing Address - Fax:305-624-2671
Practice Address - Street 1:19503 NW 57TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33055-4709
Practice Address - Country:US
Practice Address - Phone:305-621-8080
Practice Address - Fax:305-624-2671
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2010-07-29
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-05-03
Provider Licenses
StateLicense IDTaxonomies
FLME0056597207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063568500Medicaid
FL10575ZMedicare ID - Type UnspecifiedMEDICARE NUMBER
FLE61648Medicare UPIN