Provider Demographics
NPI:1023014396
Name:LORENZO, WILFREDO (MD)
Entity Type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:LORENZO
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 1:6700 CROSSWINDS DR N
Mailing Address - Street 2:STE 200A
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-5473
Mailing Address - Country:US
Mailing Address - Phone:727-344-4651
Mailing Address - Fax:727-347-6224
Practice Address - Street 1:6700 CROSSWINDS DR N
Practice Address - Street 2:STE 200A
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-5473
Practice Address - Country:US
Practice Address - Phone:727-344-4651
Practice Address - Fax:727-347-6224
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59007207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E04115Medicare UPIN
14307Medicare ID - Type Unspecified