Healthcare Provider Details

I. General information

NPI: 1275021230
Provider Name (Legal Business Name): AMIT KUMAR AGARWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 WILES RD STE 201
COCONUT CREEK FL
33073-3414
US

IV. Provider business mailing address

3001 CORAL HILLS DR STE 320
CORAL SPRINGS FL
33065-4172
US

V. Phone/Fax

Practice location:
  • Phone: 954-943-1133
  • Fax:
Mailing address:
  • Phone: 954-755-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME166874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: