Provider Demographics
NPI:1437163615
Name:DOOKERAN, NAMEETA MALA (MD)
Entity Type:Individual
Prefix:DR
First Name:NAMEETA
Middle Name:MALA
Last Name:DOOKERAN
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 1:401 E LAS OLAS BLVD STE 130-238
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2210
Mailing Address - Country:US
Mailing Address - Phone:617-953-0309
Mailing Address - Fax:
Practice Address - Street 1:1332 SW 4TH CT
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-7535
Practice Address - Country:US
Practice Address - Phone:617-953-0309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313790-01207RA0401X
CAC183908207RA0401X
AZ64943207RA0401X
FLME153695207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA114068Medicare UPIN