Healthcare Provider Details

I. General information

NPI: 1710723424
Provider Name (Legal Business Name): AHMAD MAHMOUD ABDEL-AZIZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST STE 1560
MIAMI FL
33136-2107
US

IV. Provider business mailing address

1120 NW 14TH ST STE 1560
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-7014
  • Fax: 305-243-6597
Mailing address:
  • Phone: 305-243-7014
  • Fax: 305-243-6597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number182745
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: