Provider Demographics
NPI:1932132057
Name:NODAL, SAMUEL
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:NODAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14750 NW 77TH CT STE 303
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1537
Mailing Address - Country:US
Mailing Address - Phone:305-685-5688
Mailing Address - Fax:786-618-5307
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:2006-07-09
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine