Provider Demographics
NPI:1477665263
Name:AMORNMARN, LULU (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:LULU
Middle Name:
Last Name:AMORNMARN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:5238-16 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-5005
Practice Address - Country:US
Practice Address - Phone:904-861-1222
Practice Address - Fax:904-861-2688
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61020207R00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375111200Medicaid
030005313OtherRAILROAD MEDICARE
BL140WOtherMEDICARE PTAN
BL140WOtherMEDICARE PTAN
2287707OtherAETNA HMO
1227935OtherCIGNA
FL375111200Medicaid
2287707OtherAETNA HMO