Healthcare Provider Details

I. General information

NPI: 1871765958
Provider Name (Legal Business Name): LEONARDO PROTASIO JORGE DE OLIVEIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 CLEVELAND CLINIC BLVD
WESTON FL
33331-3625
US

IV. Provider business mailing address

2950 CLEVELAND CLINIC BLVD
WESTON FL
33331-3625
US

V. Phone/Fax

Practice location:
  • Phone: 954-659-5430
  • Fax: 954-659-5427
Mailing address:
  • Phone: 954-659-5430
  • Fax: 954-659-5427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number036141537
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: