Provider Demographics
NPI:1588876098
Name:MADIWALE, MUNIR AHMED (MD)
Entity type:Individual
Prefix:DR
First Name:MUNIR
Middle Name:AHMED
Last Name:MADIWALE
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 1:5111 SW 113TH AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2826
Mailing Address - Country:US
Mailing Address - Phone:954-680-4426
Mailing Address - Fax:954-680-4426
Practice Address - Street 1:5111 SW 113TH AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33330-2826
Practice Address - Country:US
Practice Address - Phone:954-680-4426
Practice Address - Fax:954-680-4426
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 228552084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry