Healthcare Provider Details

I. General information

NPI: 1467694083
Provider Name (Legal Business Name): FELIPE TUDELA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NW 9TH AVE SUITE 201
MIAMI FL
33136-1101
US

IV. Provider business mailing address

8800 SW 85TH ST
MIAMI FL
33173-4519
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-1872
  • Fax:
Mailing address:
  • Phone: 305-274-1872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME117042
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: