Healthcare Provider Details

I. General information

NPI: 1982013710
Provider Name (Legal Business Name): WALID SEMAAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

251 NE 20TH ST APT 1201
MIAMI FL
33137-5603
US

V. Phone/Fax

Practice location:
  • Phone: 877-832-2652
  • Fax: 800-792-9021
Mailing address:
  • Phone: 248-404-5567
  • Fax: 361-371-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25165
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME168136
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: