Provider Demographics
NPI:1982667994
Name:LOCATELLI, EDUARDO R (MD, MPH)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:R
Last Name:LOCATELLI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 N FEDERAL HWY
Mailing Address - Street 2:SUITE 504
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4603
Mailing Address - Country:US
Mailing Address - Phone:954-414-9750
Mailing Address - Fax:954-414-9752
Practice Address - Street 1:4725 N FEDERAL HWY
Practice Address - Street 2:SUITE 504
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4603
Practice Address - Country:US
Practice Address - Phone:954-414-9750
Practice Address - Fax:954-414-9752
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00773652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258164700Medicaid
FL49503ZMedicare ID - Type Unspecified
FL258164700Medicaid