Provider Demographics
NPI:1902856875
Name:RADWAN, NIDAL B (MD)
Entity Type:Individual
Prefix:DR
First Name:NIDAL
Middle Name:B
Last Name:RADWAN
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 1:18100 NE 19TH AVENUE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1606
Mailing Address - Country:US
Mailing Address - Phone:305-948-8900
Mailing Address - Fax:305-948-3934
Practice Address - Street 1:18100 NE 19TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1606
Practice Address - Country:US
Practice Address - Phone:754-201-7029
Practice Address - Fax:305-948-3934
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071068207Q00000X
FLME71068193400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes193400000XGroupSingle Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117166200Medicaid
FLE1106Medicare ID - Type Unspecified
FL254331100Medicaid