Healthcare Provider Details

I. General information

NPI: 1124317342
Provider Name (Legal Business Name): CLEMENT CHOUA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 09/03/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SW 73RD ST
SOUTH MIAMI FL
33143-4679
US

IV. Provider business mailing address

PO BOX 198054
ATLANTA GA
30384-8054
US

V. Phone/Fax

Practice location:
  • Phone: 786-662-0638
  • Fax: 786-533-9236
Mailing address:
  • Phone: 786-594-6880
  • Fax: 786-533-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number266620
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number266620
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME148084
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: