Healthcare Provider Details

I. General information

NPI: 1164118345
Provider Name (Legal Business Name): EMILIO OTERMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 CLEVELAND CLINIC BLVD
WESTON FL
33331-3609
US

IV. Provider business mailing address

17897 SW 36TH ST
MIRAMAR FL
33029-1683
US

V. Phone/Fax

Practice location:
  • Phone: 954-600-6848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME179900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: