Provider Demographics
NPI:1871601740
Name:WADE, ALLISON MUIA (MD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MUIA
Last Name:WADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:DANIELLE
Other - Last Name:MUIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:930 S HARBOR CITY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1901
Mailing Address - Country:US
Mailing Address - Phone:321-345-7579
Mailing Address - Fax:833-944-2173
Practice Address - Street 1:930 S HARBOR CITY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1901
Practice Address - Country:US
Practice Address - Phone:321-345-7579
Practice Address - Fax:833-944-2173
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106167207X00000X
MOT2003015184207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLKE885OtherMEDICARE
FLKE886OtherMEDICARE
FLME106167OtherMEDICAL LICENSE
FLMX816OtherFL MEDICARE
FL146YKOtherBCBS
FLCX626YOtherMEDICARE