Healthcare Provider Details

I. General information

NPI: 1922858109
Provider Name (Legal Business Name): TAREK GHADDAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 14TH ST STE 511
MIAMI FL
33136-2116
US

IV. Provider business mailing address

777 GLADES RD
BOCA RATON FL
33431-6496
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number185246
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: