Provider Demographics
NPI:1902072044
Name:CELIS, RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:
Last Name:CELIS
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 1:605 N WASHINGTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2152
Mailing Address - Country:US
Mailing Address - Phone:321-383-7600
Mailing Address - Fax:
Practice Address - Street 1:605 N WASHINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2152
Practice Address - Country:US
Practice Address - Phone:321-383-7600
Practice Address - Fax:321-383-8111
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10031983207R00000X
FLME 123422207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease