Healthcare Provider Details

I. General information

NPI: 1053321604
Provider Name (Legal Business Name): BRUCE KOHRMAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SW 62ND AVE STE 300
SOUTH MIAMI FL
33143-4719
US

IV. Provider business mailing address

PO BOX 160010
HIALEAH FL
33016-0001
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-6501
  • Fax: 305-661-1672
Mailing address:
  • Phone: 786-924-1311
  • Fax: 786-924-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License NumberME53396
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME53396
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: