Healthcare Provider Details

I. General information

NPI: 1629034251
Provider Name (Legal Business Name): BEETHOVEN BROWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 SOUTH MIAMI AVENUE SUITE 402
MIAMI FL
33145
US

IV. Provider business mailing address

2520 SW 22ND ST STE 2 PMB 342
MIAMI FL
33145
US

V. Phone/Fax

Practice location:
  • Phone: 305-858-3430
  • Fax: 305-858-6950
Mailing address:
  • Phone: 305-858-3430
  • Fax: 305-858-6950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME0046857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: