Healthcare Provider Details

I. General information

NPI: 1336167634
Provider Name (Legal Business Name): JOHN NIVEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 LINCOLN RD 375
MIAMI BEACH FL
33139-2452
US

IV. Provider business mailing address

1111 LINCOLN RD 375
MIAMI BEACH FL
33139-2452
US

V. Phone/Fax

Practice location:
  • Phone: 305-672-7058
  • Fax: 305-672-7969
Mailing address:
  • Phone: 305-672-7058
  • Fax: 305-672-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME20864
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: