Individual
MIA ELISA BRANCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5002 W LEMON ST, TAMPA, FL 33609
(813) 286-0033
(813) 282-1806
Mailing address
PO BOX 25317, TAMPA, FL 33622-5317
(813) 286-0033
(813) 282-1806
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
MD418731
PA
207V00000X
Obstetrics & Gynecology Physician
Primary
ME87804
FL
208M00000X
Hospitalist Physician
ME87804
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267607900
—
FL
01
—
79088
BCBS
FL
01
—
MD418731
PA MEDICAL LICENSE
PA
01
—
P00093876
RAILROAD MEDICARE
—
Enumeration date
07/05/2006
Last updated
05/26/2021
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us