Provider Demographics
NPI:1538179338
Name:LANDRIN, MYRIAM (MD)
Entity type:Individual
Prefix:
First Name:MYRIAM
Middle Name:
Last Name:LANDRIN
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 1:9400 NW 12TH AVE
Mailing Address - Street 2:BAY 6
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-2025
Mailing Address - Country:US
Mailing Address - Phone:305-779-0040
Mailing Address - Fax:786-401-1394
Practice Address - Street 1:9400 NW 12TH AVE BAY 6
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2025
Practice Address - Country:US
Practice Address - Phone:305-779-0040
Practice Address - Fax:786-401-1394
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL59639207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0377600000Medicaid
FLE10522Medicare UPIN
FL0377600000Medicaid