Provider Demographics
NPI:1952521221
Name:SANTOS ACEVEDO, ADELIMELID C (MD)
Entity Type:Individual
Prefix:MRS
First Name:ADELIMELID
Middle Name:C
Last Name:SANTOS ACEVEDO
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 1:7800 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE E-214
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6741
Mailing Address - Country:US
Mailing Address - Phone:954-318-6590
Mailing Address - Fax:954-318-6604
Practice Address - Street 1:600 N HART BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6834
Practice Address - Country:US
Practice Address - Phone:407-297-0087
Practice Address - Fax:407-290-1753
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14065208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
21423Medicare ID - Type Unspecified
H81576Medicare UPIN