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NPI Code Detail

MEDICARE: CRANE ANTAWAN NIBLACK M.D.

MEDICARE: CRANE ANTAWAN NIBLACK 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
1208D00000XGeneral Practice Physician0101253456VA
2208D00000XGeneral Practice PhysicianME163136FL

General Provider Information

NPI Number : 1568628139
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRANE ANTAWAN NIBLACK M.D.
Provider Business Mailing Address
First Line : 6101 BLUE LAGOON DR STE 200
Second Line :
City : MIAMI
State : FL
Zip : 33126-3168
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1700 79TH STREET CSWY STE 120
Second Line :
City : NORTH BAY VILLAGE
State : FL
Zip : 33141-4197
Country : US
Telephone Number : 305-726-2177
Fax Number : 305-726-2209
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2008
Last Update Date : 09/02/2025

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Directions to “ CRANE ANTAWAN NIBLACK M.D.” Practice Location

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