Provider Demographics
NPI:1669498952
Name:MALVEZZI, LEOPOLDO (MD)
Entity Type:Individual
Prefix:DR
First Name:LEOPOLDO
Middle Name:
Last Name:MALVEZZI
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 1:3200 SW 60TH CT
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4000
Mailing Address - Country:US
Mailing Address - Phone:305-662-8320
Mailing Address - Fax:305-665-2467
Practice Address - Street 1:3200 SW 60TH CT
Practice Address - Street 2:SUITE # 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4000
Practice Address - Country:US
Practice Address - Phone:305-662-8320
Practice Address - Fax:305-665-2467
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-00789182086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30631200Medicaid
FL30631200Medicaid