Provider Demographics
NPI:1154354389
Name:GHADIALI, MUFADDAL (MD)
Entity type:Individual
Prefix:
First Name:MUFADDAL
Middle Name:
Last Name:GHADIALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MUFA
Other - Middle Name:
Other - Last Name:GHADIALI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6405 N FEDERAL HWY
Mailing Address - Street 2:SUITE 402
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1412
Mailing Address - Country:US
Mailing Address - Phone:954-771-8888
Mailing Address - Fax:954-491-9485
Practice Address - Street 1:6405 N FEDERAL HWY
Practice Address - Street 2:SUITE 402
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1412
Practice Address - Country:US
Practice Address - Phone:954-771-8888
Practice Address - Fax:954-491-9485
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94108208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00299422OtherRAILROAD MEDICARE
FL30015OtherBLUE CROSS BLUE SHIELD
FL300107OtherAVMED
FL7772888OtherCIGNA
FL300107OtherAVMED
FL30015YMedicare PIN