Individual
DR. TAJ M MADIWALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3100 SW 62ND AVE, MIAMI, FL 33155-3009
(305) 666-6511
Mailing address
3100 SW 62ND AVE, MIAMI, FL 33155-3009
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
ME112434
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006684600
—
FL
05
—
009962025
—
AL
01
—
051522393
BCBS PROVIDER NUMBER
AL
Enumeration date
10/06/2005
Last updated
06/09/2015
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