Healthcare Provider Details

I. General information

NPI: 1154439156
Provider Name (Legal Business Name): KALYAN RAM BHAMIDIMARRI MD., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 CLEVELAND CLINIC BLVD
WESTON FL
33331-3625
US

IV. Provider business mailing address

1611 NW 12TH AVENUE PO BOX 016960 (M851)
MIAMI FL
33101-6960
US

V. Phone/Fax

Practice location:
  • Phone: 954-659-5000
  • Fax:
Mailing address:
  • Phone: 305-243-7688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME110085
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberME 110085
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberME110085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: