Healthcare Provider Details

I. General information

NPI: 1780036574
Provider Name (Legal Business Name): MAYANK OHRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 BIRD ROAD
MIAMI FL
33175
US

IV. Provider business mailing address

11750 BIRD ROAD
MIAMI FL
33175
US

V. Phone/Fax

Practice location:
  • Phone: 305-480-6663
  • Fax:
Mailing address:
  • Phone: 305-480-6663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301119322
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: