Provider Demographics
NPI:1477661940
Name:SERRANO, EDUARDO (MD)
Entity type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:
Last Name:SERRANO
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 1:633 NW 30TH CT
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1719
Mailing Address - Country:US
Mailing Address - Phone:305-519-0383
Mailing Address - Fax:850-431-8251
Practice Address - Street 1:300 71ST ST
Practice Address - Street 2:SUITE 620
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3038
Practice Address - Country:US
Practice Address - Phone:305-866-9951
Practice Address - Fax:305-614-3352
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291950800Medicaid
FL291950800Medicaid
FLU0659ZMedicare PIN
FLV0659ZMedicare ID - Type Unspecified