Provider Demographics
NPI:1821321340
Name:ROBB WILENTZ MD LLC
Entity Type:Organization
Organization Name:ROBB WILENTZ MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBB
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-817-6596
Mailing Address - Street 1:10758 GARDEN RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-7300
Mailing Address - Country:US
Mailing Address - Phone:954-817-6596
Mailing Address - Fax:
Practice Address - Street 1:20601 E DIXIE HWY
Practice Address - Street 2:SUITE 300A
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1540
Practice Address - Country:US
Practice Address - Phone:954-817-6596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83520207ZD0900X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty