Healthcare Provider Details

I. General information

NPI: 1437225521
Provider Name (Legal Business Name): ROSE MAY SEIDE, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 SW 166TH AVE
MIRAMAR FL
33027-4445
US

IV. Provider business mailing address

2236 SW 166TH AVE
MIRAMAR FL
33027-4445
US

V. Phone/Fax

Practice location:
  • Phone: 786-402-0351
  • Fax:
Mailing address:
  • Phone: 786-402-0351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME81771
License Number StateFL

VIII. Authorized Official

Name: DR. ROSE MY SEIDE
Title or Position: PRESIDENT
Credential: M.D., PA
Phone: 786-402-0351