MEDICARE: DR. JEAN LAVENTURE RENELIEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME86189	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000114686	OTHER	FL	HUMANA
2	286602	OTHER	FL	AMERIGROUP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7124458	OTHER	FL	AETNA
5	7104	OTHER	FL	CARE ACCESS
6	299588	OTHER	FL	AVMED
7	24112208	OTHER	FL	GOLDEN RULE

General Provider Information

NPI Number	:	1215958400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN LAVENTURE RENELIEN MD

Provider Business Mailing Address
First Line	:	1325 S CONGRESS AVE STE 101
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-5802
Country	:	US
Telephone Number	:	561-733-2929
Fax Number	:	561-736-8467

Provider Business Practice Location Address
First Line	:	1325 S CONGRESS AVE STE 101
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-5802
Country	:	US
Telephone Number	:	561-733-2929
Fax Number	:	561-736-8467

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	11/11/2022

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Directions to “ DR. JEAN LAVENTURE RENELIEN MD” Practice Location

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