Healthcare Provider Details

I. General information

NPI: 1609226828
Provider Name (Legal Business Name): LUIS EDUARDO BERMUDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2016
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 NW 7TH ST STE 635
MIAMI FL
33126-3796
US

IV. Provider business mailing address

5040 NW 7TH ST STE 635
MIAMI FL
33126-3796
US

V. Phone/Fax

Practice location:
  • Phone: 305-644-2212
  • Fax: 786-475-7787
Mailing address:
  • Phone: 305-644-2212
  • Fax: 786-475-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME150411
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: