Provider Demographics
NPI:1659300887
Name:DUMENY, ELIE JR (MD)
Entity Type:Individual
Prefix:
First Name:ELIE
Middle Name:
Last Name:DUMENY
Suffix:JR
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 1:599 S FEDERAL HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:DANIA
Mailing Address - State:FL
Mailing Address - Zip Code:33004-4175
Mailing Address - Country:US
Mailing Address - Phone:954-927-2752
Mailing Address - Fax:954-927-6701
Practice Address - Street 1:599 S FEDERAL HWY STE 104
Practice Address - Street 2:
Practice Address - City:DANIA
Practice Address - State:FL
Practice Address - Zip Code:33004-4175
Practice Address - Country:US
Practice Address - Phone:954-927-2752
Practice Address - Fax:954-927-6701
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69459174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27931OtherBCBS
FL5470OtherTOTAL HEALTH CHOICE
FL3369576OtherAETNA
FL119962300Medicaid
FL51-0496988OtherTAX ID
FL2170009OtherUNITED HEALTHCARE OF FL
FL379130100Medicaid