Healthcare Provider Details

I. General information

NPI: 1295344539
Provider Name (Legal Business Name): SAMUEL BRASIL SA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

6511 SW 44TH ST
MIAMI FL
33155-5146
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2121
  • Fax:
Mailing address:
  • Phone: 407-664-4029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME163581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: