Provider Demographics
NPI:1881680908
Name:ERDEM, DENISE (MD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:ERDEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 SW 114TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5031
Mailing Address - Country:US
Mailing Address - Phone:305-666-2676
Mailing Address - Fax:305-666-3196
Practice Address - Street 1:2030 S DOUGLAS RD
Practice Address - Street 2:SUITE # 201
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4615
Practice Address - Country:US
Practice Address - Phone:305-666-2676
Practice Address - Fax:305-666-3196
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH56615Medicare UPIN
FLE6356YMedicare PIN