Healthcare Provider Details

I. General information

NPI: 1700276482
Provider Name (Legal Business Name): RENATO BERGER, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W HILLSBORO BLVD SUITE 110
COCONUT CREEK FL
33073-4395
US

IV. Provider business mailing address

5300 W HILLSBORO BLVD SUITE 110
COCONUT CREEK FL
33073-4395
US

V. Phone/Fax

Practice location:
  • Phone: 954-794-1360
  • Fax: 954-794-1367
Mailing address:
  • Phone: 954-794-1360
  • Fax: 954-794-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RENATO A BERGER
Title or Position: OWNER
Credential: MD
Phone: 954-794-1360