Provider Demographics
NPI:1033115209
Name:WILENTZ, ROBB ELLIOTT (MD)
Entity Type:Individual
Prefix:
First Name:ROBB
Middle Name:ELLIOTT
Last Name:WILENTZ
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 1:11 SENECA RD
Mailing Address - Street 2:
Mailing Address - City:SEA RANCH LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2325
Mailing Address - Country:US
Mailing Address - Phone:954-817-6596
Mailing Address - Fax:
Practice Address - Street 1:20601 E DIXIE HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1540
Practice Address - Country:US
Practice Address - Phone:305-933-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83520207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266630800Medicaid
FL266630800Medicaid
FL57934ZMedicare ID - Type Unspecified