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General NPI Number Information
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NPI Number | 1730165853
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Entity Type | Individual
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Provider Name | MATHULLA GEEVARGHESE MD
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Gender | Male
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 1101 N.W -134 AVENUE
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City | SUNRISE
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State | FL
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Zip | 33323-2914
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Country | US
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Telephone | 954-846-7588
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 N-W-134 AVE
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City | SUNRISE
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State | FL
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Zip | 33323-2914
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Country | US
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Telephone | 954-846-7588
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME63605
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License Number State | FL
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