Healthcare Provider Details

I. General information

NPI: 1962964775
Provider Name (Legal Business Name): NIKHIL VENKAT CHAVALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 14TH ST STE 609
MIAMI FL
33136-2117
US

IV. Provider business mailing address

1150 NW 14TH ST STE 609
MIAMI FL
33136-2117
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-4323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberME163956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: