Provider Demographics
NPI:1033172580
Name:GERENSTEIN, RICARDO ISRAEL (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:ISRAEL
Last Name:GERENSTEIN
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 1:20770 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1146
Mailing Address - Country:US
Mailing Address - Phone:305-467-6101
Mailing Address - Fax:786-228-4644
Practice Address - Street 1:20770 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1146
Practice Address - Country:US
Practice Address - Phone:306-467-6101
Practice Address - Fax:786-228-4644
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0081212207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261338700Medicaid
FL51208ZMedicare ID - Type Unspecified
FL261338700Medicaid