Provider Demographics
NPI:1790993525
Name:ROUDNER, LEONARD ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:ARTHUR
Last Name:ROUDNER
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 1:550 BILTMORE WAY
Mailing Address - Street 2:SUITE 890
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5730
Mailing Address - Country:US
Mailing Address - Phone:305-444-8585
Mailing Address - Fax:305-567-1519
Practice Address - Street 1:550 BILTMORE WAY
Practice Address - Street 2:SUITE 890
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5730
Practice Address - Country:US
Practice Address - Phone:305-444-8585
Practice Address - Fax:305-567-1519
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 286692086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63606Medicare UPIN