Healthcare Provider Details

I. General information

NPI: 1972232445
Provider Name (Legal Business Name): FEDOR WADI RICHANI MEINHARDT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 RACQUET CLUB RD APT 102
WESTON FL
33326-1121
US

IV. Provider business mailing address

360 RACQUET CLUB RD APT 102
WESTON FL
33326-1121
US

V. Phone/Fax

Practice location:
  • Phone: 754-303-6427
  • Fax:
Mailing address:
  • Phone: 754-303-6427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number22-301
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: