Provider Demographics
NPI:1376548560
Name:FIDALGO, EDWARD M (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:M
Last Name:FIDALGO
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 1:3659 S MIAMI AVE
Mailing Address - Street 2:STE 5005
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4221
Mailing Address - Country:US
Mailing Address - Phone:305-854-2899
Mailing Address - Fax:305-859-9677
Practice Address - Street 1:3659 S MIAMI AVE
Practice Address - Street 2:STE 5005
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4221
Practice Address - Country:US
Practice Address - Phone:305-854-2899
Practice Address - Fax:305-859-9677
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME65256207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME65256OtherMEDICAL LICENSE
FL376576800Medicaid
FL376576800Medicaid
FL376576800Medicaid