Healthcare Provider Details

I. General information

NPI: 1730611294
Provider Name (Legal Business Name): NANA GEGECHKORI MD. PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD STE 2070
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

4300 ALTON RD STE 2070
MIAMI BEACH FL
33140-2948
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2690
  • Fax: 305-674-2693
Mailing address:
  • Phone: 305-674-2690
  • Fax: 305-674-2693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME174264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: