Healthcare Provider Details

I. General information

NPI: 1780668731
Provider Name (Legal Business Name): RICHARD M FERSTENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICHARD M FERSTENBERG M.D.

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 NW 12TH AVE
MIAMI FL
33136-1002
US

IV. Provider business mailing address

1475 NW 12TH AVE
MIAMI FL
33136-1002
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-8644
  • Fax: 305-689-1820
Mailing address:
  • Phone: 305-243-8644
  • Fax: 305-689-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD19345
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number1600010
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number30008
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME146296
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: