Provider Demographics
NPI:1407818677
Name:ELIE-DEJEAN, MARIE-THERESE (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARIE-THERESE
Middle Name:
Last Name:ELIE-DEJEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE-THERESE
Other - Middle Name:
Other - Last Name:ELIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1807 NW 142 TERRACE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2857
Mailing Address - Country:US
Mailing Address - Phone:954-885-9782
Mailing Address - Fax:954-885-9782
Practice Address - Street 1:7900 NW 27 AVE
Practice Address - Street 2:STE 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-4902
Practice Address - Country:US
Practice Address - Phone:305-693-8888
Practice Address - Fax:305-693-8893
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55450208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
A36469Medicare ID - Type Unspecified
G36078Medicare UPIN