Provider Demographics
NPI:1558431700
Name:CORONADO, ELSY M (MD)
Entity Type:Individual
Prefix:
First Name:ELSY
Middle Name:M
Last Name:CORONADO
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 1:3601 FEDERAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137
Mailing Address - Country:US
Mailing Address - Phone:305-376-6611
Mailing Address - Fax:305-576-0008
Practice Address - Street 1:3601 FEDERAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137
Practice Address - Country:US
Practice Address - Phone:305-376-6611
Practice Address - Fax:305-576-0008
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91527208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI532Y / EFF 7-11-10OtherMEDICARE
FL265596900Medicaid