Provider Demographics
NPI:1487628582
Name:MENDES, FLAVIA OLIVEIRA (MD)
Entity Type:Individual
Prefix:
First Name:FLAVIA
Middle Name:OLIVEIRA
Last Name:MENDES
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 1:7500 SW 87TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5426
Mailing Address - Country:US
Mailing Address - Phone:305-913-0666
Mailing Address - Fax:305-913-0663
Practice Address - Street 1:7500 SW 87TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5426
Practice Address - Country:US
Practice Address - Phone:305-913-0666
Practice Address - Fax:305-913-0663
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0096220207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN075796900Medicaid
FL2760533-00Medicaid
MN075796900Medicaid
FLAB438Medicare PIN
MN110233992Medicare ID - Type UnspecifiedRAILROAD
H58038Medicare UPIN