Healthcare Provider Details

I. General information

NPI: 1568843654
Provider Name (Legal Business Name): PAUL A MADERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 N MIAMI AVE STE 107
MIAMI FL
33127-3523
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 786-885-6192
  • Fax: 786-228-1859
Mailing address:
  • Phone: 305-821-8611
  • Fax: 305-827-1753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME137178
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: