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General NPI Number Information
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NPI Number | 1427322882
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE OB-GYN PLLC
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 6464 N MIAMI AVE
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City | MIAMI
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State | FL
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Zip | 33150-4520
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Country | US
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Telephone | 786-657-2269
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Fax | 786-955-6972
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Provider Business Mailing Address
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Address Line | 6464 N MIAMI AVE
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City | MIAMI
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State | FL
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Zip | 33150-4520
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Country | US
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Telephone | 786-657-2269
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Fax | 786-955-6972
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Authorized Official
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Title or Position | MD
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Name | EDY AMISIAL
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Credential | MD
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Telephone | 786-657-2269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME108552
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License Number State | FL
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