Healthcare Provider Details

I. General information

NPI: 1174657167
Provider Name (Legal Business Name): FRANCESCO LUPIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 KITTS LN
NEWINGTON CT
06111-4250
US

IV. Provider business mailing address

8400 NW 33RD ST SUITE 201
DORAL FL
33122-1937
US

V. Phone/Fax

Practice location:
  • Phone: 844-307-4827
  • Fax: 305-402-0855
Mailing address:
  • Phone: 786-408-8502
  • Fax: 305-402-0855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number50637
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35090341
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number050637
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: