Healthcare Provider Details

I. General information

NPI: 1760623557
Provider Name (Legal Business Name): MANMEET SINGH AHLUWALIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
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: 305-279-7778
Mailing address:
  • Phone: 786-594-6880
  • Fax: 786-533-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME147802
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number87141
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: