Healthcare Provider Details

I. General information

NPI: 1750680229
Provider Name (Legal Business Name): JOHN NIVEN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 ARTHUR GODFREY RD 202
MIAMI BEACH FL
33140-3641
US

IV. Provider business mailing address

333 ARTHUR GODFREY RD 202
MIAMI BEACH FL
33140-3641
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberME20864
License Number StateFL

VIII. Authorized Official

Name: JOHN NIVEN
Title or Position: PRESIDENT
Credential: MD
Phone: 305-672-7058