Healthcare Provider Details

I. General information

NPI: 1891784427
Provider Name (Legal Business Name): PIERRE PHILIPPE NICOLAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 NW 119TH ST
MIAMI FL
33168-2522
US

IV. Provider business mailing address

671 NW 119TH ST
MIAMI FL
33168-2522
US

V. Phone/Fax

Practice location:
  • Phone: 305-688-0811
  • Fax: 305-688-6304
Mailing address:
  • Phone: 305-688-0811
  • Fax: 305-688-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME 92302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: