Healthcare Provider Details

I. General information

NPI: 1699568188
Provider Name (Legal Business Name): PHD MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10155 COLLINS AVE
BAL HARBOUR FL
33154-1655
US

IV. Provider business mailing address

10155 COLLINS AVE
BAL HARBOUR FL
33154-1655
US

V. Phone/Fax

Practice location:
  • Phone: 551-206-1222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ABRAHAM KNOLL
Title or Position: OWNER
Credential: MD
Phone: 551-206-1222