Provider Demographics
NPI:1356304455
Name:CESPEDES, EDGARDO M (MD)
Entity type:Individual
Prefix:
First Name:EDGARDO
Middle Name:M
Last Name:CESPEDES
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 1:11160 SW 88TH ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-0949
Mailing Address - Country:US
Mailing Address - Phone:305-596-2325
Mailing Address - Fax:305-596-2288
Practice Address - Street 1:11160 SW 88TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-0949
Practice Address - Country:US
Practice Address - Phone:305-596-2325
Practice Address - Fax:305-596-2288
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056985207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259441200Medicaid
FL11551OtherPTAN
FL11551OtherPTAN