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NPI Code Detail

MEDICARE: DR. ADAM RENNEISEN DO

MEDICARE: DR. ADAM RENNEISEN 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
1207P00000XEmergency Medicine PhysicianOS23130FL

General Provider Information

NPI Number : 1720782550
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ADAM RENNEISEN DO
Provider Business Mailing Address
First Line : 2500 NE 23RD ST
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33062-1116
Country : US
Telephone Number : 954-296-0053
Fax Number :
Provider Business Practice Location Address
First Line : 1600 SW ARCHER RD
Second Line :
City : GAINESVILLE
State : FL
Zip : 32610-3003
Country : US
Telephone Number : 352-265-0111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2023
Last Update Date : 06/01/2026

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