Provider Demographics
NPI:1417914219
Name:WEINBACH, BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:WEINBACH
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 1:20950 NE 27TH CT
Mailing Address - Street 2:SUITE 303
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1232
Mailing Address - Country:US
Mailing Address - Phone:305-682-8088
Mailing Address - Fax:305-682-8014
Practice Address - Street 1:20950 NE 27TH CT
Practice Address - Street 2:SUITE 303
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1232
Practice Address - Country:US
Practice Address - Phone:305-682-8088
Practice Address - Fax:305-682-8014
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036936174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000417OtherNHP
FL066545200Medicaid
FLD63659Medicare UPIN
FL95924Medicare ID - Type Unspecified