Provider Demographics
NPI:1578762688
Name:STIMAGE RIVERS, AEISHA KEKHIA (MD)
Entity Type:Individual
Prefix:
First Name:AEISHA
Middle Name:KEKHIA
Last Name:STIMAGE RIVERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AEISHA
Other - Middle Name:KEKHIA
Other - Last Name:STIMAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:1951 SW 172ND AVE STE 313
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5614
Practice Address - Country:US
Practice Address - Phone:954-265-4325
Practice Address - Fax:954-538-5558
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1325912086X0206X, 2086X0206X
TXP7193208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021491600Medicaid