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General NPI Number Information
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NPI Number | 1073545802
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Entity Type | Individual
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Provider Name | RENATO GONIK MD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 1801 W SAMPLE RD STE 101
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City | DEERFIELD BEACH
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State | FL
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Zip | 33064-1370
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Country | US
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Telephone | 954-888-3800
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Fax | 954-888-3808
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Provider Business Mailing Address
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Address Line | 1700 NW 49TH ST STE 125
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-3750
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Country | US
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Telephone | 954-888-3800
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Fax | 954-888-3808
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | ME78708
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License Number State | FL
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