Healthcare Provider Details

I. General information

NPI: 1558545046
Provider Name (Legal Business Name): VINOOP VISWANATHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE DEPARTMENT OF ANESTHESIOLOGY, JACKSON MEMORIAL HOSPITAL
MIAMI FL
33136-1005
US

IV. Provider business mailing address

9375 SW 77TH AVE APT NO 3023
MIAMI FL
33156-7944
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6973
  • Fax:
Mailing address:
  • Phone: 305-595-7978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberTRN7889
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: