MEDICARE: AMIT UPADHIAYA DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS9136	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417938499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIT UPADHIAYA DO

Provider Business Mailing Address
First Line	:	1 W SAMPLE RD
Second Line	:	#201
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-3547
Country	:	US
Telephone Number	:	954-782-3170
Fax Number	:	954-782-3171

Provider Business Practice Location Address
First Line	:	1 W SAMPLE RD
Second Line	:	#201
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-3547
Country	:	US
Telephone Number	:	954-782-3170
Fax Number	:	954-782-3171

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	12/29/2014

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Directions to “ AMIT UPADHIAYA DO” Practice Location

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