MEDICARE: DR. JULVET CHEPNGUM MBIANDA MD

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	207RC0000X	Cardiovascular Disease Physician	036171017	IL
2	207RC0000X	Cardiovascular Disease Physician	15437	SD
3	207RI0011X	Interventional Cardiology Physician	036171017	IL
4	207RI0011X	Interventional Cardiology Physician	MD615645599	WA

General Provider Information

NPI Number	:	1609398999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULVET CHEPNGUM MBIANDA MD

Provider Business Mailing Address
First Line	:	507 S 21ST AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-5015
Country	:	US
Telephone Number	:	781-292-0250
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 S 21ST AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-5015
Country	:	US
Telephone Number	:	781-292-0250
Fax Number	:

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

Provider Enumeration Date	:	07/09/2017
Last Update Date	:	12/03/2025

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