Provider Demographics
NPI:1740687821
Name:MIAMI LAKES MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:MIAMI LAKES MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIZALDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-621-8051
Mailing Address - Street 1:15536 NW 77TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5804
Mailing Address - Country:US
Mailing Address - Phone:305-621-8051
Mailing Address - Fax:305-621-8053
Practice Address - Street 1:15536 NW 77TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5804
Practice Address - Country:US
Practice Address - Phone:305-621-8051
Practice Address - Fax:305-621-8053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2025-06-03
Deactivation Date:2025-04-16
Deactivation Code:
Reactivation Date:2025-06-03
Provider Licenses
StateLicense IDTaxonomies
FLPA9106732363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty