Provider Demographics
NPI:1568454916
Name:OYADIRAN, CARLINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLINE
Middle Name:
Last Name:OYADIRAN
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 1:1930 SW 195TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5912
Mailing Address - Country:US
Mailing Address - Phone:954-392-7616
Mailing Address - Fax:
Practice Address - Street 1:20215 NW 2ND AVE STE 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-2538
Practice Address - Country:US
Practice Address - Phone:305-685-5688
Practice Address - Fax:305-652-4545
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2017-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00072933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268479900Medicaid
FL268479900OtherMEDIPASS