Provider Demographics
NPI:1396797437
Name:A ENRIQUE WHITTWELL MD PA
Entity type:Organization
Organization Name:A ENRIQUE WHITTWELL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:WHITTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-621-3897
Mailing Address - Street 1:8950 N KENDALL DR
Mailing Address - Street 2:STE 304
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2144
Mailing Address - Country:US
Mailing Address - Phone:786-621-3897
Mailing Address - Fax:305-675-2788
Practice Address - Street 1:8950 N KENDALL DR
Practice Address - Street 2:STE 304
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2144
Practice Address - Country:US
Practice Address - Phone:786-621-3897
Practice Address - Fax:305-675-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98566OtherBLUE CROSS BLUE SHIELD
FL98566OtherBLUE CROSS BLUE SHIELD
FLD50651Medicare UPIN