Provider Demographics
NPI:1740236058
Name:LUIS, EUGEN (MD)
Entity type:Individual
Prefix:
First Name:EUGEN
Middle Name:
Last Name:LUIS
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 1:351 NW 42ND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5685
Mailing Address - Country:US
Mailing Address - Phone:305-643-8130
Mailing Address - Fax:
Practice Address - Street 1:351 NW 42ND AVE STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5685
Practice Address - Country:US
Practice Address - Phone:305-643-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 95216207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113465800Medicaid
FL280107800Medicaid