MEDICARE: CESARE RZADKOWOLSKI RAOLI M.D.

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	2084P0800X	Psychiatry Physician	ME60415	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME60415	OTHER	FL	STATE LICENSE NUMBER
2	14460	OTHER	FL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1306975305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CESARE RZADKOWOLSKI RAOLI M.D.

Provider Business Mailing Address
First Line	:	2001 NW 7TH ST
Second Line	:	SUITE 300
City	:	MIAMI
State	:	FL
Zip	:	33125-3479
Country	:	US
Telephone Number	:	305-631-0202
Fax Number	:	305-668-6277

Provider Business Practice Location Address
First Line	:	12315 SW 64TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-5538
Country	:	US
Telephone Number	:	305-631-0202
Fax Number	:	305-668-6277

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	11/08/2007

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