Provider Demographics
NPI:1639124563
Name:MITRANI-SEVY, SALOMON (MD)
Entity Type:Individual
Prefix:DR
First Name:SALOMON
Middle Name:
Last Name:MITRANI-SEVY
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 1:9829 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3993
Mailing Address - Country:US
Mailing Address - Phone:305-551-6666
Mailing Address - Fax:305-551-1900
Practice Address - Street 1:9829 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3993
Practice Address - Country:US
Practice Address - Phone:305-551-6666
Practice Address - Fax:305-551-1900
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066969208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376686100Medicaid
FL26163Medicare ID - Type Unspecified
FLF95810Medicare UPIN