Provider Demographics
NPI:1003859315
Name:HANABERGH, RODOLFO (MD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:HANABERGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7490 SW 23RD STREET
Mailing Address - Street 2:201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155
Mailing Address - Country:US
Mailing Address - Phone:786-615-3013
Mailing Address - Fax:786-953-7514
Practice Address - Street 1:7490 SW 23RD ST
Practice Address - Street 2:201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1419
Practice Address - Country:US
Practice Address - Phone:786-615-3013
Practice Address - Fax:786-953-7514
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E75626Medicare UPIN
FL25998ZMedicare PIN
E75626Medicare UPIN