Healthcare Provider Details

I. General information

NPI: 1336385913
Provider Name (Legal Business Name): BRETT WENLEDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE. (C-301)
MIAMI FL
33136
US

IV. Provider business mailing address

1700 NW NORTH RIVER DR APT 701
MIAMI FL
33125-2351
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6970
  • Fax: 305-545-6501
Mailing address:
  • Phone: 305-519-6174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberTRN11457
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberTRN11457
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberTRN11457
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: