MEDICARE: NIZAR H TAKI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	252499	MA

General Provider Information

NPI Number	:	1164783551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIZAR H TAKI M.D.

Provider Business Mailing Address
First Line	:	915 MIDDLE RIVER DR STE 104A
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3559
Country	:	US
Telephone Number	:	305-330-3223
Fax Number	:	754-218-0825

Provider Business Practice Location Address
First Line	:	915 MIDDLE RIVER DR STE 104A
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3559
Country	:	US
Telephone Number	:	305-330-3223
Fax Number	:	754-218-0825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2012
Last Update Date	:	02/01/2022

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