Healthcare Provider Details

I. General information

NPI: 1528565868
Provider Name (Legal Business Name): KERRY ELLIS FINE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 SW 72ND ST
MIAMI FL
33173-3205
US

IV. Provider business mailing address

9300 SW 72ND ST
MIAMI FL
33173-3205
US

V. Phone/Fax

Practice location:
  • Phone: 305-330-4959
  • Fax:
Mailing address:
  • Phone: 305-330-4959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS22908
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: