Provider Demographics
NPI:1922050590
Name:SERENTILL, LUIS H (PHYSICIAN/MD)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:H
Last Name:SERENTILL
Suffix:
Gender:M
Credentials:PHYSICIAN/MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145
Mailing Address - Country:US
Mailing Address - Phone:305-446-3534
Mailing Address - Fax:786-703-5693
Practice Address - Street 1:13933 17TH ST STE 200
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-4604
Practice Address - Country:US
Practice Address - Phone:352-437-5972
Practice Address - Fax:352-437-5974
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0018498208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059309500Medicaid
FL059309500Medicaid
FL78026XMedicare ID - Type Unspecified