Healthcare Provider Details

I. General information

NPI: 1225295892
Provider Name (Legal Business Name): ARIEL GASTROENTEROLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE SUITE 412
HIALEAH FL
33016-1897
US

IV. Provider business mailing address

12400 SW 1ST CT
PLANTATION FL
33325-2702
US

V. Phone/Fax

Practice location:
  • Phone: 305-820-0006
  • Fax: 305-828-6700
Mailing address:
  • Phone: 954-483-8335
  • Fax: 305-828-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0044788
License Number StateFL

VIII. Authorized Official

Name: DR. WILSON NICOLAS OTERO
Title or Position: REGISTERED AGENT/GASTROENTEROLOGIST
Credential: M.D.
Phone: 954-483-8422