Healthcare Provider Details

I. General information

NPI: 1285997239
Provider Name (Legal Business Name): NITIN A WADHWA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2012
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 CORAL HILLS DR
CORAL SPRINGS FL
33065-4172
US

IV. Provider business mailing address

2121 FOX POINT CIR
DE PERE WI
54115-3316
US

V. Phone/Fax

Practice location:
  • Phone: 954-341-2916
  • Fax:
Mailing address:
  • Phone: 954-655-3082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number73981
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number16364
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: