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General NPI Number Information
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NPI Number | 1164672556
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Entity Type | Individual
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Provider Name | KAILASH S AMRUTHUR M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 3501 JOHNSON ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5421
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Country | US
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Telephone | 954-437-4800
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Fax | 954-437-6628
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Provider Business Mailing Address
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Address Line | 550 N. HIATUS RD SUITE 200
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City | PEMBROKE PINES
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State | FL
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Zip | 33026
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Country | US
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Telephone | 954-437-4800
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Fax | 954-436-6628
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME110700
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License Number State | FL
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