Provider Demographics
NPI:1477827012
Name:CAMILLE DENIS
Entity Type:Organization
Organization Name:CAMILLE DENIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DENIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-758-9702
Mailing Address - Street 1:5525 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2548
Mailing Address - Country:US
Mailing Address - Phone:305-758-9702
Mailing Address - Fax:305-757-8640
Practice Address - Street 1:5525 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2548
Practice Address - Country:US
Practice Address - Phone:305-758-9702
Practice Address - Fax:305-757-8640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066763300Medicaid
FL92947Medicare UPIN