Healthcare Provider Details

I. General information

NPI: 1346230786
Provider Name (Legal Business Name): JUST BRAHMATEWARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 BISCAYNE BLVD SUITE 200
MIAMI FL
33138-6284
US

IV. Provider business mailing address

PO BOX 226411
MIAMI FL
33122-6411
US

V. Phone/Fax

Practice location:
  • Phone: 305-751-7771
  • Fax: 305-756-0270
Mailing address:
  • Phone: 305-751-7771
  • Fax: 305-756-0270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberME71993
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA69617
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberME71993
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberA69617
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME71993
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA69617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: