Provider Demographics
NPI:1649236837
Name:GEADA, LUIS G (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:G
Last Name:GEADA
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 1:3821 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3640
Mailing Address - Country:US
Mailing Address - Phone:305-226-0817
Mailing Address - Fax:305-226-2672
Practice Address - Street 1:3821 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3640
Practice Address - Country:US
Practice Address - Phone:305-226-0817
Practice Address - Fax:305-226-2672
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049511500Medicaid
FLD21153Medicare UPIN
FL07120Medicare ID - Type Unspecified