Individual
LAURA J. ELISEO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1400 NW 12TH AVE, MIAMI, FL 33136-1003
(305) 689-5464
Mailing address
1400 NW 12TH AVE, MIAMI, FL 33136-1003
(305) 689-5464
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
224022
MA
207P00000X
Emergency Medicine Physician
Primary
ME117686
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110041043A
—
MA
01
—
462236
TUFTS
MA
01
—
J28754
BCBS
MA
Enumeration date
03/20/2006
Last updated
01/10/2014
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