Healthcare Provider Details

I. General information

NPI: 1679026983
Provider Name (Legal Business Name): CANTAVE CHARLOT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NE 125TH ST
NORTH MIAMI FL
33161-5936
US

IV. Provider business mailing address

30 E ELM ST APT 3G
LINDEN NJ
07036-2976
US

V. Phone/Fax

Practice location:
  • Phone: 305-685-5688
  • Fax: 305-688-7995
Mailing address:
  • Phone: 732-481-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN888
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: