Healthcare Provider Details

I. General information

NPI: 1699087932
Provider Name (Legal Business Name): RAPHAEL YECHIELI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 05/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 NW 12TH AVE STE 1500
MIAMI FL
33136
US

IV. Provider business mailing address

1475 NW 12TH AVE STE 1500
MIAMI FL
33136-1002
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-5965
  • Fax:
Mailing address:
  • Phone: 305-243-5965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME120897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: