Provider Demographics
NPI:1881630382
Name:VERDECIA, LUIS FELIPE SR (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:FELIPE
Last Name:VERDECIA
Suffix:SR
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 1:1240 NW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167-3232
Mailing Address - Country:US
Mailing Address - Phone:305-685-5688
Mailing Address - Fax:305-688-7995
Practice Address - Street 1:1272 NW 119TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33167-3232
Practice Address - Country:US
Practice Address - Phone:305-685-5688
Practice Address - Fax:305-687-1817
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81400208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260500700Medicaid
FLH36045Medicare UPIN
FL260500700Medicaid