Provider Demographics
NPI:1245238179
Name:MUKHERJEE MUKHOPADHYAY, SIBDAS (MD)
Entity Type:Individual
Prefix:DR
First Name:SIBDAS
Middle Name:
Last Name:MUKHERJEE MUKHOPADHYAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14750 NW 77TH CT STE 106
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1507
Mailing Address - Country:US
Mailing Address - Phone:305-698-4000
Mailing Address - Fax:305-698-4014
Practice Address - Street 1:14750 NW 77TH CT STE 106
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1507
Practice Address - Country:US
Practice Address - Phone:305-698-4000
Practice Address - Fax:305-698-4014
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172503174400000X
FLME142611207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01076159Medicaid
NY01076159Medicaid
NYG20777Medicare UPIN