Healthcare Provider Details

I. General information

NPI: 1578852117
Provider Name (Legal Business Name): ELLIOTT J ELIAS MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 SW 87TH AVE STE 100
MIAMI FL
33173
US

IV. Provider business mailing address

7400 SW 87TH AVE STE 100
MIAMI FL
33173-5458
US

V. Phone/Fax

Practice location:
  • Phone: 305-275-8200
  • Fax: 305-274-7812
Mailing address:
  • Phone: 305-275-8200
  • Fax: 305-274-7812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number265775
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number265775
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: