Healthcare Provider Details

I. General information

NPI: 1659508596
Provider Name (Legal Business Name): FELIPE FERREIRA SOUZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 NW 12TH AVE
MIAMI FL
33136-1002
US

IV. Provider business mailing address

1475 NW 12TH AVE
MIAMI FL
33136-1002
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-5512
  • Fax: 305-243-4613
Mailing address:
  • Phone: 305-243-5512
  • Fax: 305-243-4613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME141076
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: