Provider Demographics
NPI:1073545802
Name:GONIK, RENATO (MD)
Entity Type:Individual
Prefix:DR
First Name:RENATO
Middle Name:
Last Name:GONIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RENATO
Other - Middle Name:
Other - Last Name:GONIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-888-3800
Mailing Address - Fax:954-888-3808
Practice Address - Street 1:1801 W SAMPLE RD STE 101
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1370
Practice Address - Country:US
Practice Address - Phone:954-888-3800
Practice Address - Fax:954-888-3808
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME787082084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261697100Medicaid
FL019925100Medicaid
FL261697100Medicaid