Provider Demographics
NPI:1467516518
Name:FREDDY AVNI MD PA
Entity Type:Organization
Organization Name:FREDDY AVNI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:AVNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-204-4687
Mailing Address - Street 1:1395 S STATE ROAD 7
Mailing Address - Street 2:SUITE 420
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9327
Mailing Address - Country:US
Mailing Address - Phone:561-204-4687
Mailing Address - Fax:561-204-4694
Practice Address - Street 1:1395 S STATE ROAD 7
Practice Address - Street 2:SUITE 420
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9327
Practice Address - Country:US
Practice Address - Phone:561-204-4687
Practice Address - Fax:561-204-4694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250393000Medicaid
FL250393000Medicaid
FLG04763Medicare UPIN