Healthcare Provider Details

I. General information

NPI: 1992092258
Provider Name (Legal Business Name): KEITH PEREIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE # WW279
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE # WW279
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-8178
  • Fax: 305-585-5743
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number2085R0204X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: