Healthcare Provider Details

I. General information

NPI: 1093792657
Provider Name (Legal Business Name): RICHARD GERSHANIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8390 W FLAGLER ST STE. 107
MIAMI FL
33144-2039
US

IV. Provider business mailing address

8390 W FLAGLER ST STE 107
MIAMI FL
33144-2039
US

V. Phone/Fax

Practice location:
  • Phone: 305-551-8088
  • Fax: 305-551-7603
Mailing address:
  • Phone: 305-551-8088
  • Fax: 305-551-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME0053136
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0053136
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: