=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346464542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARMINE GIOVANNI NUDO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 NW 12TH AVE 1101
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33136-1051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-243-5787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 BRICKELL BAY DR APT. 2109
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33131-2950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-479-2902
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0008X
-----------------------------------------------------
Taxonomy Name | Hepatology Physician
-----------------------------------------------------
License Number | ME98441
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------