Healthcare Provider Details

I. General information

NPI: 1730529041
Provider Name (Legal Business Name): RAKESH RAVIKUMARAN NAIR M.D., MPH., MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 SW 8TH ST
MIAMI FL
33199-2516
US

IV. Provider business mailing address

1561 SW 106TH TER
DAVIE FL
33324-7165
US

V. Phone/Fax

Practice location:
  • Phone: 305-348-0690
  • Fax:
Mailing address:
  • Phone: 786-428-7113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME124750
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME124750
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number17990
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: