Healthcare Provider Details

I. General information

NPI: 1689817256
Provider Name (Legal Business Name): KELLY SUZANNE LIKER MD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 NW 12TH AVE
MIAMI FL
33136-2140
US

IV. Provider business mailing address

1265 NW 12TH AVE
MIAMI FL
33136-2140
US

V. Phone/Fax

Practice location:
  • Phone: 305-547-6800
  • Fax:
Mailing address:
  • Phone: 305-243-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License NumberME182574
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME182574
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: