Healthcare Provider Details

I. General information

NPI: 1770678179
Provider Name (Legal Business Name): EMANUEL NACCARATO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NE 167TH ST
NORTH MIAMI BEACH FL
33162-2304
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 305-940-0522
  • Fax: 305-931-1957
Mailing address:
  • Phone: 305-500-2000
  • Fax: 305-931-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0053968
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME53968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: