Healthcare Provider Details

I. General information

NPI: 1194457994
Provider Name (Legal Business Name): MUGHILVALAVAN GOVARDHANAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 BRICKELL AVE STE 900
MIAMI FL
33131-3800
US

IV. Provider business mailing address

3150 EMERALD POINTE DR APT 103A
HOLLYWOOD FL
33021-1337
US

V. Phone/Fax

Practice location:
  • Phone: 330-284-3672
  • Fax:
Mailing address:
  • Phone: 330-284-3672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME176228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: