MEDICARE: NIDAL RADWAN M.D. PA

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

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	:	1942259361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIDAL RADWAN M.D. PA

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 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

Authorized Official
Title or Position	:	PRESIDNET
Name	:	NIDAL BAZ RADWAN
Credential	:	MD
Telephone Number	:	305-948-8900

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	05/18/2022

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