Provider Demographics
NPI:1952373474
Name:ELENSI, EDET (MD)
Entity Type:Individual
Prefix:
First Name:EDET
Middle Name:
Last Name:ELENSI
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 1:19909 TAMIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3366
Mailing Address - Country:US
Mailing Address - Phone:813-468-1899
Mailing Address - Fax:813-468-1899
Practice Address - Street 1:19909 TAMIAMI AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3366
Practice Address - Country:US
Practice Address - Phone:813-468-1899
Practice Address - Fax:813-468-1899
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I42381Medicare UPIN
FL28753XMedicare UPIN