Healthcare Provider Details

I. General information

NPI: 1902339880
Provider Name (Legal Business Name): EDGAR SIYAKURIMA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

PO BOX 198054
ATLANTA GA
30384-8054
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-7670
  • Fax: 786-533-9711
Mailing address:
  • Phone: 786-596-7670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME147655
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: