Provider Demographics
NPI:1003258583
Name:SUMOZA, LUIS DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:DAVID
Last Name:SUMOZA
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 1:100 NW 170TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5510
Mailing Address - Country:US
Mailing Address - Phone:786-785-7567
Mailing Address - Fax:786-785-7585
Practice Address - Street 1:100 NW 170TH ST STE 207
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5510
Practice Address - Country:US
Practice Address - Phone:786-785-7567
Practice Address - Fax:786-785-7585
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME164064207RH0000X, 207RX0202X
IL036126207207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200084858Medicaid