Provider Demographics
NPI:1346230786
Name:BRAHMATEWARI, JUST (MD)
Entity Type:Individual
Prefix:
First Name:JUST
Middle Name:
Last Name:BRAHMATEWARI
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:PO BOX 226411
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-6411
Mailing Address - Country:US
Mailing Address - Phone:305-751-7771
Mailing Address - Fax:305-756-0270
Practice Address - Street 1:6301 BISCAYNE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-6284
Practice Address - Country:US
Practice Address - Phone:305-751-7771
Practice Address - Fax:305-756-0270
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71993207ND0900X, 207NP0225X, 207NS0135X
CAA69617207ND0900X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26233000Medicaid
FLE5508Medicare ID - Type Unspecified
FL26233000Medicaid