Healthcare Provider Details

I. General information

NPI: 1811131246
Provider Name (Legal Business Name): SENTHUR JEYAMURUGAN THANGASAMY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE WW 279
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611, NW 12 AVE, WW279 WW 279 JACKSON MEMORIAL MEDICAL CENTER
MIAMI FL
33136
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-8178
  • Fax: 305-355-4051
Mailing address:
  • Phone: 305-858-8178
  • Fax: 305-355-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberTRN 12309
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: