Healthcare Provider Details

I. General information

NPI: 1154587988
Provider Name (Legal Business Name): RONEN Y HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176
US

IV. Provider business mailing address

1613 N. HARRISON PARKWAY SUITE 200, MAILSTOP SH-9A
SUNRISE FL
33323-2896
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-1960
  • Fax: 608-263-0575
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number57529
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME117457
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: