Provider Demographics
NPI:1043242639
Name:BLONDET, RICARDO H (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:H
Last Name:BLONDET
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 1:295 NE 51ST ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2883
Mailing Address - Country:US
Mailing Address - Phone:305-342-0750
Mailing Address - Fax:
Practice Address - Street 1:295 NE 51ST ST APT 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2883
Practice Address - Country:US
Practice Address - Phone:305-342-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57204207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64314900Medicaid
FL64314900Medicaid
BM823ZMedicare PIN