Healthcare Provider Details

I. General information

NPI: 1225692577
Provider Name (Legal Business Name): CRISTOBAL DUCAUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

15621 SW 75TH AVE
PALMETTO BAY FL
33157-2411
US

V. Phone/Fax

Practice location:
  • Phone: 305-695-1255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME168763
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME168763
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: