=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407118094
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARJUN DHAWALE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2012
-----------------------------------------------------
Last Update Date | 06/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1611 NW 12TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33136-1005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-585-7275
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1611 NW 12TH AVE REHAB CENTER, ROOM 303
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33136-1005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-585-7275
-----------------------------------------------------
Fax | 305-324-7658
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | TRN #17347
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------