Provider Demographics
NPI:1194058784
Name:FIDELITY HEALTH SERVICES PA
Entity type:Organization
Organization Name:FIDELITY HEALTH SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-281-2813
Mailing Address - Street 1:9703 S DIXIE HWY
Mailing Address - Street 2:STE # 17
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-8114
Mailing Address - Country:US
Mailing Address - Phone:305-281-2813
Mailing Address - Fax:305-238-5171
Practice Address - Street 1:9703 S DIXIE HWY
Practice Address - Street 2:STE # 17
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-8114
Practice Address - Country:US
Practice Address - Phone:305-281-2813
Practice Address - Fax:305-238-5171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 96575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty