Provider Demographics
NPI:1720413164
Name:BENDIK, ELISE (MS, CGC)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:BENDIK
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3242 MARY ST
Mailing Address - Street 2:S310
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-5294
Mailing Address - Country:US
Mailing Address - Phone:217-766-8007
Mailing Address - Fax:
Practice Address - Street 1:1501 NW 10TH AVE
Practice Address - Street 2:BRB 334 (M-860)
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1012
Practice Address - Country:US
Practice Address - Phone:305-243-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL590624458OtherTAX ID