Provider Demographics
NPI:1982164141
Name:GHIWOT, YONATAN (MD)
Entity Type:Individual
Prefix:
First Name:YONATAN
Middle Name:
Last Name:GHIWOT
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 1:8117 PRESTON RD STE 800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6328
Mailing Address - Country:US
Mailing Address - Phone:214-666-9548
Mailing Address - Fax:972-587-7122
Practice Address - Street 1:2623 S SEACREST BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7501
Practice Address - Country:US
Practice Address - Phone:561-735-6553
Practice Address - Fax:561-735-7739
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL151744207R00000X
TX5904207R00000X
FL390200000X
VA0101275304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program