Healthcare Provider Details

I. General information

NPI: 1487639308
Provider Name (Legal Business Name): JOEL KERTZNUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W 68TH ST SUITE 300
HIALEAH FL
33016-1815
US

IV. Provider business mailing address

2140 W 68TH ST SUITE 305
HIALEAH FL
33016-1815
US

V. Phone/Fax

Practice location:
  • Phone: 305-822-4107
  • Fax: 305-822-5086
Mailing address:
  • Phone: 305-822-4107
  • Fax: 786-497-2989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME89004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: