Provider Demographics
NPI:1922032937
Name:PARDAVE, JULIO EMIL (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:EMIL
Last Name:PARDAVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2000 ISLAND BLVD
Mailing Address - Street 2:APARTMENT 301
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4957
Mailing Address - Country:US
Mailing Address - Phone:305-937-2538
Mailing Address - Fax:305-826-0263
Practice Address - Street 1:7150 W 20TH AVE
Practice Address - Street 2:# 604
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5529
Practice Address - Country:US
Practice Address - Phone:305-826-4699
Practice Address - Fax:305-826-0263
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0028505174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0948167OtherAETNA PRVDR #
FL202054OtherAMERIGROUP PRVDR
FL259684900Medicaid
FL650618366OtherTAX ID#
FL005860OtherNEIGHBORHOOD PRVDR #
FL0588781-002OtherCIGNA PRVDR #
FL92407OtherBLUE CROSS BLUE SHIELD #
FL03894OtherSTAYWELL/WELLCARE