Provider Demographics
NPI:1043259468
Name:KOUTOUBY, RAGHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:RAGHAD
Middle Name:
Last Name:KOUTOUBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8525 SW 92ND ST STE C11A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7386
Mailing Address - Country:US
Mailing Address - Phone:305-512-3345
Mailing Address - Fax:844-323-3689
Practice Address - Street 1:8525 SW 92ND ST STE C11A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7386
Practice Address - Country:US
Practice Address - Phone:305-512-3345
Practice Address - Fax:844-323-3689
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00559472080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373857400Medicaid
FL23524Medicare ID - Type Unspecified