Provider Demographics
NPI:1467447888
Name:EKLADIOS, EMAD E (MD)
Entity type:Individual
Prefix:
First Name:EMAD
Middle Name:E
Last Name:EKLADIOS
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 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5663
Mailing Address - Fax:954-276-0301
Practice Address - Street 1:140A S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-3623
Practice Address - Country:US
Practice Address - Phone:954-265-8100
Practice Address - Fax:954-922-6898
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2019-11-14
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
173000000X
FLME64340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375033700Medicaid
F66279Medicare UPIN
FL375033700Medicaid