Provider Demographics
NPI:1639274608
Name:RESNIK, SORREL S (MD)
Entity Type:Individual
Prefix:
First Name:SORREL
Middle Name:S
Last Name:RESNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9065 S.W. 87TH AVENUE
Mailing Address - Street 2:S.109
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176
Mailing Address - Country:US
Mailing Address - Phone:305-275-1222
Mailing Address - Fax:305-271-3206
Practice Address - Street 1:9065 S.W. 87TH AVENUE
Practice Address - Street 2:S.109
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-275-1222
Practice Address - Fax:305-271-3206
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME9901207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL90991OtherBLUE CROSS BLUE SHIELD
FL90991OtherBLUE CROSS BLUE SHIELD