Provider Demographics
NPI:1417170499
Name:MEMET, BEATRICE LUSIANA (MD)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:LUSIANA
Last Name:MEMET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4862
Mailing Address - Country:US
Mailing Address - Phone:772-567-4311
Mailing Address - Fax:772-794-1450
Practice Address - Street 1:3450 11TH CT
Practice Address - Street 2:SUITE 302B
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5012
Practice Address - Country:US
Practice Address - Phone:772-794-1444
Practice Address - Fax:772-794-1450
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045763207RR0500X
FLME128604207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology