Provider Demographics
NPI:1073519971
Name:WILENTZ, JOEL MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:MARC
Last Name:WILENTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3722
Mailing Address - Country:US
Mailing Address - Phone:954-454-1066
Mailing Address - Fax:954-456-4025
Practice Address - Street 1:2100 E HALLANDALE BEACH BLVD
Practice Address - Street 2:STE 100
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3722
Practice Address - Country:US
Practice Address - Phone:954-454-1066
Practice Address - Fax:954-456-4025
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME14840207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51724Medicare UPIN
FL06818VMedicare ID - Type Unspecified