Healthcare Provider Details

I. General information

NPI: 1962252874
Provider Name (Legal Business Name): KAVAN MAGUIRE MULLOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 NW 9TH AVE
MIAMI FL
33136-1409
US

IV. Provider business mailing address

350 S MIAMI AVE APT 712
MIAMI FL
33130-1916
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-7000
  • Fax:
Mailing address:
  • Phone: 224-243-1501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: