Healthcare Provider Details

I. General information

NPI: 1043411150
Provider Name (Legal Business Name): REYAN AZAD GHANY MD, FACC, FASE, RPVI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 NE 162ND ST
NORTH MIAMI BEACH FL
33161
US

IV. Provider business mailing address

1000 PARK CENTRE BLVD SUITE 100
MIAMI FL
33169-5373
US

V. Phone/Fax

Practice location:
  • Phone: 305-949-0999
  • Fax:
Mailing address:
  • Phone: 305-621-0023
  • Fax: 305-623-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME101246
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME101246
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: