Provider Demographics
NPI:1346337144
Name:LOUIS, EMLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:EMLYN
Middle Name:
Last Name:LOUIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2718 LEE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1537
Mailing Address - Country:US
Mailing Address - Phone:239-288-0840
Mailing Address - Fax:239-244-2195
Practice Address - Street 1:214 S 1ST ST STE AANDB
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-3950
Practice Address - Country:US
Practice Address - Phone:239-867-4568
Practice Address - Fax:239-244-2195
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLACN256208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100615900Medicaid