Provider Demographics
NPI:1043232028
Name:ECHARTE, LUIS JORGE (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:JORGE
Last Name:ECHARTE
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 1:15680 N KENDALL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1159
Mailing Address - Country:US
Mailing Address - Phone:305-436-9933
Mailing Address - Fax:305-500-2137
Practice Address - Street 1:21110 BISCAYNE BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1227
Practice Address - Country:US
Practice Address - Phone:305-466-0030
Practice Address - Fax:305-466-4755
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87094207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277032600Medicaid
FL31064OtherBLUE CROSS BLUE SHIELD
FLU8108XMedicare PIN
FLU8108UMedicare PIN
FL31064OtherBLUE CROSS BLUE SHIELD