Healthcare Provider Details

I. General information

NPI: 1396799383
Provider Name (Legal Business Name): JAROSLAV F ONDRUSEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JERRY F ONDRUSEK MD

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 EAST OAKLAND PARK BLVD SUITE 100
FORT LAUDERDALE FL
33306-1889
US

IV. Provider business mailing address

2598 NW 27TH ST
BOCA RATON FL
33434-3654
US

V. Phone/Fax

Practice location:
  • Phone: 954-302-3750
  • Fax: 954-343-1016
Mailing address:
  • Phone: 954-303-3750
  • Fax: 954-343-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME69418
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: