Healthcare Provider Details

I. General information

NPI: 1790882066
Provider Name (Legal Business Name): EVELYN ROISMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 SW 84 AVENUE
MIAMI FL
33155
US

IV. Provider business mailing address

15112 SW 74 PLACE
MIAMI FL
33158
US

V. Phone/Fax

Practice location:
  • Phone: 305-267-3700
  • Fax: 305-262-6099
Mailing address:
  • Phone: 305-238-2669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME26581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: