Provider Demographics
NPI:1750378709
Name:DAVILA, ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
Last Name:DAVILA
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 1:1959 SECOFFEE ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-3210
Mailing Address - Country:US
Mailing Address - Phone:305-856-8288
Mailing Address - Fax:
Practice Address - Street 1:21150 BISCAYNE BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1226
Practice Address - Country:US
Practice Address - Phone:305-384-6100
Practice Address - Fax:305-545-6687
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31035207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272190200Medicaid
D63704Medicare UPIN
FL96035UMedicare PIN
FL96035WMedicare PIN