MEDICARE: DR. MUNIR AHMED MADIWALE 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	2084P0804X	Child & Adolescent Psychiatry Physician	ME 22855	FL

General Provider Information

NPI Number	:	1588876098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUNIR AHMED MADIWALE M.D.

Provider Business Mailing Address
First Line	:	5111 SW 113TH AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33330-2826
Country	:	US
Telephone Number	:	954-680-4426
Fax Number	:	954-680-4426

Provider Business Practice Location Address
First Line	:	5111 SW 113TH AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33330-2826
Country	:	US
Telephone Number	:	954-680-4426
Fax Number	:	954-680-4426

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/09/2007

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