Healthcare Provider Details

I. General information

NPI: 1932158987
Provider Name (Legal Business Name): BAHJAT F GHANEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 SW 10TH ST
PEMBROKE PINES FL
33027-1833
US

IV. Provider business mailing address

13400 SW 10TH ST
PEMBROKE PINES FL
33027-1833
US

V. Phone/Fax

Practice location:
  • Phone: 954-900-1466
  • Fax:
Mailing address:
  • Phone: 954-900-1466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0066087
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: