Provider Demographics
NPI:1386949345
Name:ELIAS A M FEANNY MD PA
Entity type:Organization
Organization Name:ELIAS A M FEANNY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FEANNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-253-8869
Mailing Address - Street 1:9275 SW 152ND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1701
Mailing Address - Country:US
Mailing Address - Phone:305-253-8869
Mailing Address - Fax:305-233-9726
Practice Address - Street 1:9275 SW 152 STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157
Practice Address - Country:US
Practice Address - Phone:305-253-8869
Practice Address - Fax:305-233-9726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250480100Medicaid
G87955Medicare UPIN
44392Medicare PIN