Provider Demographics
NPI:1275627895
Name:ELISME, JUNIE FLEURINORD (MD)
Entity Type:Individual
Prefix:DR
First Name:JUNIE
Middle Name:FLEURINORD
Last Name:ELISME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUNIE
Other - Middle Name:
Other - Last Name:FLEURINORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-462-8323
Mailing Address - Fax:954-463-1149
Practice Address - Street 1:2866 E OAKLAND PARK BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1819
Practice Address - Country:US
Practice Address - Phone:954-462-8323
Practice Address - Fax:954-463-1149
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 70067208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250010800Medicaid
FLH40206 0001Medicare UPIN