Healthcare Provider Details

I. General information

NPI: 1154379550
Provider Name (Legal Business Name): TAMIKA M MAXWELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 N STATE ROAD 7
LAUDERDALE LAKES FL
33319-5862
US

IV. Provider business mailing address

900 S PINE ISLAND RD SUITE 800
PLANTATION FL
33324-3920
US

V. Phone/Fax

Practice location:
  • Phone: 954-486-8020
  • Fax: 954-486-8983
Mailing address:
  • Phone: 305-821-8611
  • Fax: 305-827-1753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS9737
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: