Provider Demographics
NPI:1437303658
Name:CHOUSLEB, ELIAS (MD)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:CHOUSLEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NW 170TH ST STE 410
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5511
Mailing Address - Country:US
Mailing Address - Phone:305-654-6850
Mailing Address - Fax:305-654-6858
Practice Address - Street 1:100 NW 170TH ST STE 410
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5511
Practice Address - Country:US
Practice Address - Phone:305-654-6850
Practice Address - Fax:305-654-6858
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104145208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0013015-00Medicaid