Healthcare Provider Details

I. General information

NPI: 1184679508
Provider Name (Legal Business Name): CESAR A RANDICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500N FEDERAL HWY 113B
LIGHTHOUSE POINT FL
33064-6521
US

IV. Provider business mailing address

4500N FEDERAL HWY 113B
LIGHTHOUSE POINT FL
33064-6521
US

V. Phone/Fax

Practice location:
  • Phone: 954-547-2510
  • Fax:
Mailing address:
  • Phone: 954-547-2510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME75583
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: