Healthcare Provider Details

I. General information

NPI: 1588059844
Provider Name (Legal Business Name): ADHIRAJ GOSINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

6207 ROBINSON ST
JUPITER FL
33458-6628
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6388
  • Fax: 305-243-6372
Mailing address:
  • Phone: 561-346-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME145813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: