Provider Demographics
NPI:1811956683
Name:CEFALU, ELIZABETH MUDDIMAN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MUDDIMAN
Last Name:CEFALU
Suffix:
Gender:
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2572 COMMERCE PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34289-9332
Mailing Address - Country:US
Mailing Address - Phone:941-888-5839
Mailing Address - Fax:941-888-5840
Practice Address - Street 1:2572 COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34289-9332
Practice Address - Country:US
Practice Address - Phone:941-888-5839
Practice Address - Fax:941-888-5840
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108366207R00000X, 208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015644200005Medicaid
PA0017552440002Medicaid
FL002888900Medicaid
FL14AC7OtherBCBS FLORIDA
FLP00913647OtherRR MEDICARE
FL14AC7OtherBCBS FLORIDA
PA028019Medicare ID - Type UnspecifiedINDIV PROV # FOR MCARE
FLP00913647OtherRR MEDICARE
PAG97920Medicare UPIN
PA110185140Medicare ID - Type UnspecifiedMCARE RAILROAD #