Provider Demographics
NPI:1154379550
Name:MAXWELL, TAMIKA M (DO)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:M
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:305-821-8611
Mailing Address - Fax:305-827-1753
Practice Address - Street 1:4400 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5862
Practice Address - Country:US
Practice Address - Phone:954-486-8020
Practice Address - Fax:954-486-8983
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2014-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS9737208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275295600Medicaid