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NPI Code Detail

MEDICARE: RENAUD EDOUARD MD

MEDICARE: RENAUD EDOUARD 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
1208D00000XGeneral Practice Physician24598PR
2261QP2300XPrimary Care Clinic/Center24598PR
3208D00000XGeneral Practice PhysicianACN1749FL

General Provider Information

NPI Number : 1780415075
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENAUD EDOUARD MD
Provider Business Mailing Address
First Line : 8333 NW 53RD ST FL 6
Second Line :
City : DORAL
State : FL
Zip : 33166-4783
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1650 S CONGRESS AVE
Second Line :
City : PALM SPRINGS
State : FL
Zip : 33461-2175
Country : US
Telephone Number : 561-272-7714
Fax Number : 561-968-3334
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2024
Last Update Date : 06/03/2026

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