Healthcare Provider Details

I. General information

NPI: 1053602292
Provider Name (Legal Business Name): ALI M MAZIAD MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SW 62ND AVE STE 600
SOUTH MIAMI FL
33143-4728
US

IV. Provider business mailing address

5996 SW 70 STREET, FL 5
SOUTH MIAMI FL
33143-3540
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-7577
  • Fax: 305-284-7688
Mailing address:
  • Phone: 305-284-7577
  • Fax: 305-284-7688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME144970
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA141965
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME144970
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA141965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: