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General NPI Number Information
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NPI Number | 1598217507
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Entity Type | Organization
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Legal Business Name | DR GIDWANI M D LLC
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 3920 SW 186TH WAY
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City | MIRAMAR
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State | FL
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Zip | 33029-2720
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Country | US
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Telephone | 844-443-9264
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Fax |
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Provider Business Mailing Address
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Address Line | 3920 SW 186TH WAY
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City | MIRAMAR
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State | FL
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Zip | 33029-2720
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Country | US
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Telephone | 844-443-9264
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RAJA GIDWANI
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Credential | M.D.
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Telephone | 844-443-9264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME111199
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | ME109293
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License Number State | FL
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