Provider Demographics
NPI:1922165737
Name:WOLFENZON, ABRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:WOLFENZON
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:PO BOX 100707
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2506
Mailing Address - Country:US
Mailing Address - Phone:305-434-3070
Mailing Address - Fax:
Practice Address - Street 1:91550 OVERSEAS HWY STE 215
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2513
Practice Address - Country:US
Practice Address - Phone:305-434-3070
Practice Address - Fax:786-260-0511
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 55815207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372354200Medicaid
FL372354200Medicaid
FL098805Medicare ID - Type Unspecified