Healthcare Provider Details

I. General information

NPI: 1538588207
Provider Name (Legal Business Name): MOHAMMED EZUDDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NW 170TH ST
NORTH MIAMI BEACH FL
33169-5521
US

IV. Provider business mailing address

4581 WESTON ROAD BOX 327
WESTON FL
33331-3141
US

V. Phone/Fax

Practice location:
  • Phone: 305-651-1100
  • Fax:
Mailing address:
  • Phone: 305-654-5221
  • Fax: 305-654-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME130108
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA192219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: