MEDICARE: DR. NIDAL B RADWAN 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	207Q00000X	Family Medicine Physician	ME0071068	FL

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	:	1902856875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIDAL B RADWAN MD

Provider Business Mailing Address
First Line	:	18100 NE 19TH AVENUE
Second Line	:	SUITE #102
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-1606
Country	:	US
Telephone Number	:	305-948-8900
Fax Number	:	305-948-3934

Provider Business Practice Location Address
First Line	:	18100 NE 19TH AVE STE 102
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-1606
Country	:	US
Telephone Number	:	754-201-7029
Fax Number	:	305-948-3934

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	03/11/2024

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