Healthcare Provider Details

I. General information

NPI: 1568014082
Provider Name (Legal Business Name): KEVIN SOUZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 W 49TH PL STE 500
HIALEAH FL
33012-3158
US

IV. Provider business mailing address

1435 W 49TH PL STE 500
HIALEAH FL
33012-3158
US

V. Phone/Fax

Practice location:
  • Phone: 305-392-0380
  • Fax:
Mailing address:
  • Phone: 305-392-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number72730
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME146756
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME146756
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29094
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number85674
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: