Healthcare Provider Details

I. General information

NPI: 1780562694
Provider Name (Legal Business Name): KAMAL MATLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 SW ARCHER RD
GAINESVILLE FL
32608-1134
US

IV. Provider business mailing address

PO BOX 100288
GAINESVILLE FL
32610-0277
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-9928
  • Fax:
Mailing address:
  • Phone: 352-265-9928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME182410
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number1025369
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1025369
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: