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General NPI Number Information
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NPI Number | 1982006102
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Entity Type | Organization
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Legal Business Name | KETEVAN VLADI PLLC
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 2925 AVENTURA BLVD SUITE 101
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City | AVENTURA
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State | FL
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Zip | 33180-3124
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Country | US
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Telephone | 305-931-7424
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Fax |
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Provider Business Mailing Address
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Address Line | 1504 BAY RD APT 2503
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City | MIAMI BEACH
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State | FL
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Zip | 33139-3279
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Country | US
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Telephone | 917-753-4770
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | KETEVAN VLADI
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Credential | MD
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Telephone | 917-753-4770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME103381
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License Number State | FL
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