Provider Demographics
NPI:1417078841
Name:PELLERANO, CESAR M (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:M
Last Name:PELLERANO
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 1:2999 NE 191ST ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3123
Mailing Address - Country:US
Mailing Address - Phone:305-933-8877
Mailing Address - Fax:305-933-3244
Practice Address - Street 1:2999 NE 191ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3123
Practice Address - Country:US
Practice Address - Phone:305-933-8877
Practice Address - Fax:305-933-3244
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35555207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024320OtherNHP
FL96189OtherBLUE CROSS BLUE SHIELD
FLP00079248OtherRAILROAD MEDICARE
FL206898OtherAVMED
FLD27958Medicare UPIN
FL96189OtherBLUE CROSS BLUE SHIELD