Healthcare Provider Details

I. General information

NPI: 1164751095
Provider Name (Legal Business Name): RHU-JADE M RAGUINDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N WICKHAM RD STE 204
MELBOURNE FL
32935-8660
US

IV. Provider business mailing address

2675 WINKLER AVE S3TE 200
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 321-308-5050
  • Fax: 321-984-9497
Mailing address:
  • Phone: 877-856-3774
  • Fax: 321-984-9497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME106285
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: