Healthcare Provider Details

I. General information

NPI: 1427110501
Provider Name (Legal Business Name): KRISTINE H O'PHELAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST
MIAMI FL
33136
US

IV. Provider business mailing address

1120 NW 14TH ST
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6175
  • Fax:
Mailing address:
  • Phone: 305-243-6175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME102998
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberME102998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: