Healthcare Provider Details

I. General information

NPI: 1326230442
Provider Name (Legal Business Name): AMAR DILIP RAJADHYAKSHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 SW 90TH ST SUITE 201
MIAMI FL
33186-2182
US

IV. Provider business mailing address

11801 SW 90TH ST SUITE 201
MIAMI FL
33186-2182
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-1317
  • Fax: 305-595-0157
Mailing address:
  • Phone: 305-595-1317
  • Fax: 305-595-0157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number243296
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME96884
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: