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NPI Code Detail

MEDICARE: DR. VLADIMIR DERENONCOURT DO

MEDICARE: DR. VLADIMIR DERENONCOURT DO
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
1207Q00000XFamily Medicine PhysicianOS7487FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518921428
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VLADIMIR DERENONCOURT DO
Provider Business Mailing Address
First Line : 11645 BISCAYNE BLVD STE 207
Second Line :
City : NORTH MIAMI
State : FL
Zip : 33181-3138
Country : US
Telephone Number : 305-538-8835
Fax Number : 305-994-0054
Provider Business Practice Location Address
First Line : 11645 BISCAYNE BLVD STE 302
Second Line :
City : NORTH MIAMI
State : FL
Zip : 33181-3138
Country : US
Telephone Number : 305-538-8835
Fax Number : 305-994-0054
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2006
Last Update Date : 11/18/2024

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