Provider Demographics
NPI:1962602482
Name:KUYUMJIAN, EMIE (MD)
Entity type:Individual
Prefix:DR
First Name:EMIE
Middle Name:
Last Name:KUYUMJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:3571 DEL PRADO BLVD N
Practice Address - Street 2:SUITE 2
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-5286
Practice Address - Country:US
Practice Address - Phone:239-656-6300
Practice Address - Fax:239-656-6765
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3473979OtherCIGNA
FLP00756984OtherRR MEDICARE
FL145X8OtherBCBS
FL001351700Medicaid
FL3473979OtherCIGNA