Healthcare Provider Details

I. General information

NPI: 1104977362
Provider Name (Legal Business Name): RONALDO A CALONJE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 N UNIVERSITY DR SUITE 206
TAMARAC FL
33321-2979
US

IV. Provider business mailing address

7401 N UNIVERSITY DR SUITE 206
TAMARAC FL
33321-2979
US

V. Phone/Fax

Practice location:
  • Phone: 954-718-2230
  • Fax:
Mailing address:
  • Phone: 954-718-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME95141
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: