Healthcare Provider Details

I. General information

NPI: 1730995796
Provider Name (Legal Business Name): DR MIAMI BEACH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 41ST ST STE 412
MIAMI BEACH FL
33140-3500
US

IV. Provider business mailing address

400 W 41ST ST STE 412
MIAMI BEACH FL
33140-3500
US

V. Phone/Fax

Practice location:
  • Phone: 786-703-7549
  • Fax:
Mailing address:
  • Phone: 786-703-7549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TARIK HUSAIN
Title or Position: OWNER
Credential: MD
Phone: 786-703-7549