Provider Demographics
NPI:1871603290
Name:AMIR, ROTEM (MD)
Entity type:Individual
Prefix:DR
First Name:ROTEM
Middle Name:
Last Name:AMIR
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 1:1250 E HALLANDALE BEACH BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4641
Mailing Address - Country:US
Mailing Address - Phone:954-302-8161
Mailing Address - Fax:754-345-0575
Practice Address - Street 1:1250 E HALLANDALE BEACH BLVD STE 700
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4641
Practice Address - Country:US
Practice Address - Phone:954-302-8161
Practice Address - Fax:754-345-0575
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 96739207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277702900Medicaid
FLAA493YMedicare PIN