Provider Demographics
NPI:1639432149
Name:EDGARDO M CESPEDES M D P A
Entity Type:Organization
Organization Name:EDGARDO M CESPEDES M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:CESPEDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-596-2325
Mailing Address - Street 1:11160 SW 88TH ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-0949
Mailing Address - Country:US
Mailing Address - Phone:305-596-2325
Mailing Address - Fax:305-596-2288
Practice Address - Street 1:11160 SW 88TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-0949
Practice Address - Country:US
Practice Address - Phone:305-596-2325
Practice Address - Fax:305-596-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0056985207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE66277Medicare UPIN