| Nidal Radwan M.d. Pa | |
|
18100 Ne 19th Avenue Suite #102 North Miami Beach FL 33162-1606 | |
| (305) 948-8900 | |
| (305) 948-3934 |
| Full Name | Nidal Radwan M.d. Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 18100 Ne 19th Avenue, North Miami Beach, Florida |
| Authorized Official Name and Position | Nidal Baz Radwan (PRESIDNET) |
| Authorized Official Contact | 3059488900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nidal Radwan M.d. Pa 18100 Ne 19th Avenue Suite #102 North Miami Beach FL 33162-1606 Ph: (305) 948-8900 | Nidal Radwan M.d. Pa 18100 Ne 19th Avenue Suite #102 North Miami Beach FL 33162-1606 Ph: (305) 948-8900 |
| NPI Number | 1942259361 |
|---|---|
| Provider Enumeration Date | 05/10/2006 |
| Last Update Date | 05/18/2022 |
| Medicare PECOS PAC ID | 3375792252 |
|---|---|
| Medicare Enrollment ID | O20121009000800 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942259361 | NPI | - | NPPES |
| 254331100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Nidal B Radwan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902856875 PECOS PAC ID: 4880589092 Enrollment ID: I20040217000808 |
| Provider Name | Elizabeth Bocanegra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235708645 PECOS PAC ID: 4082018098 Enrollment ID: I20210812000126 |
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