Provider Demographics
NPI:1093792657
Name:GERSHANIK, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GERSHANIK
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 1:8390 W FLAGLER ST
Mailing Address - Street 2:STE 107
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2039
Mailing Address - Country:US
Mailing Address - Phone:305-551-8088
Mailing Address - Fax:305-551-7603
Practice Address - Street 1:8390 W FLAGLER ST
Practice Address - Street 2:STE. 107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2039
Practice Address - Country:US
Practice Address - Phone:305-551-8088
Practice Address - Fax:305-551-7603
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053136207T00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048196300Medicaid
FL048196300Medicaid
FLD85819Medicare UPIN