Healthcare Provider Details

I. General information

NPI: 1801679519
Provider Name (Legal Business Name): LEONARDO FURTADO FREITAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

10650 SW 77TH AVE
PINECREST FL
33156-3704
US

V. Phone/Fax

Practice location:
  • Phone: 319-383-3896
  • Fax:
Mailing address:
  • Phone: 319-383-3896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License NumberSP-0268
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME169514
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberSP-0268
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: