Healthcare Provider Details

I. General information

NPI: 1073542353
Provider Name (Legal Business Name): MAVARA M AGRAWAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SW 108TH AVE
MIAMI FL
33174-2555
US

IV. Provider business mailing address

800 SW 108TH AVE
MIAMI FL
33174-2555
US

V. Phone/Fax

Practice location:
  • Phone: 305-348-3627
  • Fax: 305-348-4261
Mailing address:
  • Phone: 305-348-3627
  • Fax: 305-348-4261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME83232
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME83232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: