Provider Demographics
NPI:1174560569
Name:NAZARALLY, NASIRUDDIN (MD)
Entity type:Individual
Prefix:DR
First Name:NASIRUDDIN
Middle Name:
Last Name:NAZARALLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1846 SW 153RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4316
Mailing Address - Country:US
Mailing Address - Phone:954-447-0386
Mailing Address - Fax:305-899-1352
Practice Address - Street 1:888 NE 126TH ST
Practice Address - Street 2:101
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4964
Practice Address - Country:US
Practice Address - Phone:305-899-1406
Practice Address - Fax:305-899-1352
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067939207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG11114Medicare UPIN