Dr Luis Eduardo Aviles-lopez, MD | |
1454 Madison Ave W, Immokalee, FL 34142-2200 | |
(239) 658-3011 | |
(239) 658-3070 |
Full Name | Dr Luis Eduardo Aviles-lopez |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 1454 Madison Ave W, Immokalee, Florida |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1891985032 | NPI | - | NPPES |
371593100 | Medicaid | FL | |
1468134 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | MD15467R (Louisiana) | Secondary |
208000000X | Pediatrics | ME59851 (Florida) | Primary |
Entity Name | Collier Health Services, Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1609827211 PECOS PAC ID: 4183521925 Enrollment ID: O20040210000106 |
Mailing Address | Practice Location Address |
---|---|
Dr Luis Eduardo Aviles-lopez, MD 1454 Madison Ave W, Immokalee, FL 34142-2200 Ph: (239) 658-3011 | Dr Luis Eduardo Aviles-lopez, MD 1454 Madison Ave W, Immokalee, FL 34142-2200 Ph: (239) 658-3011 |
Alexandra Bianca Sarac, D.O. Pediatrics Medicare: Medicare Enrolled Practice Location: 1441 Heritage Blvd, Immokalee, FL 34142 Phone: 239-658-3000 Fax: 237-658-3175 | |
Dr. Adela M De Vera, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1441 Heritage Blvd, Immokalee, FL 34142 Phone: 239-658-3000 | |
Flora Consul Sakornsin, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1454 Madison Ave W, Immokalee, FL 34142 Phone: 239-658-3000 | |
Jerry Williamson, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 1454 Madison Ave W, Immokalee, FL 34142 Phone: 239-658-3196 Fax: 239-658-3175 | |
Dr. Rathna Bushan, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1454 Madison Ave W, Immokalee, FL 34142 Phone: 239-965-8300 Fax: 239-658-3175 | |
Dawn M Bertram-stewart, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1454 Madison Ave W, Immokalee, FL 34142 Phone: 239-658-3000 |