Healthcare Provider Details

I. General information

NPI: 1548835176
Provider Name (Legal Business Name): ANTONIO ROKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 N FEDERAL HWY
FT LAUDERDALE FL
33308-4668
US

IV. Provider business mailing address

4725 N FEDERAL HWY
FT LAUDERDALE FL
33308-4668
US

V. Phone/Fax

Practice location:
  • Phone: 954-938-3359
  • Fax: 954-492-5790
Mailing address:
  • Phone: 954-938-3359
  • Fax: 954-492-5790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number162854
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: