Provider Demographics
NPI:1366550949
Name:CORDOVES, LOURDES A (MD)
Entity type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:A
Last Name:CORDOVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 W 21ST CT
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3946
Mailing Address - Country:US
Mailing Address - Phone:305-556-3671
Mailing Address - Fax:305-556-7740
Practice Address - Street 1:6450 W 21ST CT
Practice Address - Street 2:SUITE 305
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-3946
Practice Address - Country:US
Practice Address - Phone:305-556-3671
Practice Address - Fax:305-556-7740
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043561207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96414Medicare ID - Type UnspecifiedMEDICARE
FLD27984Medicare UPIN