Healthcare Provider Details

I. General information

NPI: 1255891982
Provider Name (Legal Business Name): YEVGENIY KHARONOV DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 14TH ST STE 713
MIAMI FL
33136-2118
US

IV. Provider business mailing address

1150 NW 14TH ST STE 713
MIAMI FL
33136-2118
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-1579
  • Fax: 305-243-3435
Mailing address:
  • Phone: 305-243-1579
  • Fax: 305-243-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1016458
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS21816
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: