Provider Demographics
NPI:1295137214
Name:PHILOGENE, FITZ (AP)
Entity type:Individual
Prefix:
First Name:FITZ
Middle Name:
Last Name:PHILOGENE
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12620 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-6504
Mailing Address - Country:US
Mailing Address - Phone:786-715-6380
Mailing Address - Fax:
Practice Address - Street 1:3900 NW 79TH AVE
Practice Address - Street 2:SUITE 598
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6556
Practice Address - Country:US
Practice Address - Phone:786-715-6380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3514171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist