Provider Demographics
NPI:1205281409
Name:EKLADIOS, MINA (MD)
Entity type:Individual
Prefix:DR
First Name:MINA
Middle Name:
Last Name:EKLADIOS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:727-376-4040
Mailing Address - Fax:727-376-8824
Practice Address - Street 1:10710 STATE ROAD 54 STE 108
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-2263
Practice Address - Country:US
Practice Address - Phone:727-376-4040
Practice Address - Fax:727-376-8824
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME163708208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119275800Medicaid