Provider Demographics
NPI:1154707180
Name:ELIZABETH MUDDIMAN CEFALU MD MPH PLLC
Entity type:Organization
Organization Name:ELIZABETH MUDDIMAN CEFALU MD MPH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:CEFALU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-806-8920
Mailing Address - Street 1:2572 COMMERCE PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34289-9332
Mailing Address - Country:US
Mailing Address - Phone:941-888-5839
Mailing Address - Fax:941-888-5840
Practice Address - Street 1:2572 COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34289-9332
Practice Address - Country:US
Practice Address - Phone:941-888-5839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108366207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty