Provider Demographics
NPI:1205906518
Name:PEREZ-BURNES, LUIS MARIA (MD)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:MARIA
Last Name:PEREZ-BURNES
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 1:2121 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5224
Mailing Address - Country:US
Mailing Address - Phone:305-447-4150
Mailing Address - Fax:305-448-4448
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-668-5500
Practice Address - Fax:305-662-8344
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80531208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259840000Medicaid
FLE5836ZMedicare ID - Type Unspecified
FL259840000Medicaid