Provider Demographics
NPI:1760845135
Name:ELIACIN, LUDGER GIRARDO (MD)
Entity Type:Individual
Prefix:
First Name:LUDGER
Middle Name:GIRARDO
Last Name:ELIACIN
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 1:10526 WHEELHOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1214
Mailing Address - Country:US
Mailing Address - Phone:516-462-6856
Mailing Address - Fax:
Practice Address - Street 1:5200 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2706
Practice Address - Country:US
Practice Address - Phone:305-762-9244
Practice Address - Fax:847-375-2854
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139926207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine