Healthcare Provider Details

I. General information

NPI: 1023407780
Provider Name (Legal Business Name): ENL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 S DIXIE HWY
MIAMI FL
33176-7224
US

IV. Provider business mailing address

11767 S DIXIE HWY SUITE 357
MIAMI FL
33156-4438
US

V. Phone/Fax

Practice location:
  • Phone: 786-342-8082
  • Fax: 800-404-0732
Mailing address:
  • Phone: 786-342-8082
  • Fax: 800-404-0732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ELLIOT N LANG
Title or Position: PRESIDENT
Credential: MD
Phone: 786-342-8082