Healthcare Provider Details

I. General information

NPI: 1750378972
Provider Name (Legal Business Name): SIDDHARTHA VENKATAPPA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR MIAMI CANCER INSTITUTE
MIAMI FL
33176-2118
US

IV. Provider business mailing address

PO BOX 743144
ATLANTA GA
30374-3144
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME0090219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: