Healthcare Provider Details

I. General information

NPI: 1669454617
Provider Name (Legal Business Name): WOLFSDORF RASZYNSKI & SUSSMANE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-2639
  • Fax: 305-663-0530
Mailing address:
  • Phone: 305-662-2639
  • Fax: 305-663-0530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDRE RASZYNSKI
Title or Position: PRESIDENT
Credential: MD
Phone: 305-662-2639