Healthcare Provider Details

I. General information

NPI: 1053831628
Provider Name (Legal Business Name): KONSTANTIN URAZOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SHERIDAN ST STE C
HOLLYWOOD FL
33021-3416
US

IV. Provider business mailing address

12350 NW 39TH ST STE 200
CORAL SPRINGS FL
33065-2418
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-3252
  • Fax: 954-678-3007
Mailing address:
  • Phone: 954-248-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME145819
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME145819
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: