Provider Demographics
NPI:1154742088
Name:DR EDEL ABREU MD PA
Entity type:Organization
Organization Name:DR EDEL ABREU MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABREU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-819-6666
Mailing Address - Street 1:6875 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5337
Mailing Address - Country:US
Mailing Address - Phone:305-819-6666
Mailing Address - Fax:305-824-1222
Practice Address - Street 1:6875 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5337
Practice Address - Country:US
Practice Address - Phone:305-819-6666
Practice Address - Fax:305-824-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066445208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25421Medicare PIN
FLF86153Medicare UPIN