Healthcare Provider Details

I. General information

NPI: 1073545802
Provider Name (Legal Business Name): RENATO GONIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RENATO GONIK

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W SAMPLE RD STE 101
DEERFIELD BEACH FL
33064-1370
US

IV. Provider business mailing address

1700 NW 49TH ST STE 125
FORT LAUDERDALE FL
33309-3750
US

V. Phone/Fax

Practice location:
  • Phone: 954-888-3800
  • Fax: 954-888-3808
Mailing address:
  • Phone: 954-888-3800
  • Fax: 954-888-3808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME78708
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: