Provider Demographics
NPI:1740242361
Name:HADDAD, ELIE R (MD)
Entity Type:Individual
Prefix:
First Name:ELIE
Middle Name:R
Last Name:HADDAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 430820
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33243-0820
Mailing Address - Country:US
Mailing Address - Phone:305-661-0169
Mailing Address - Fax:888-811-4447
Practice Address - Street 1:8500 SW 92ND ST
Practice Address - Street 2:B208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7390
Practice Address - Country:US
Practice Address - Phone:305-661-0169
Practice Address - Fax:888-811-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 93281207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16161ZMedicare ID - Type Unspecified
FLI37877Medicare UPIN