MEDICARE: DR. AMIR GOLDENBERG 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	207R00000X	Internal Medicine Physician	ME126279	FL
2	207R00000X	Internal Medicine Physician	S9886	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295720746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIR GOLDENBERG M.D.

Provider Business Mailing Address
First Line	:	1395 NW 167TH ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-5710
Country	:	US
Telephone Number	:	713-429-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	8411 W BELLFORT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2205
Country	:	US
Telephone Number	:	713-429-0808
Fax Number	:

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	03/31/2021

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