Provider Demographics
NPI:1245284090
Name:ACEVEDO, ROLANDO (MD)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:
Last Name:ACEVEDO
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 1:10796 PINES BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3919
Mailing Address - Country:US
Mailing Address - Phone:954-443-5688
Mailing Address - Fax:954-432-9882
Practice Address - Street 1:10796 PINES BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3919
Practice Address - Country:US
Practice Address - Phone:954-443-5688
Practice Address - Fax:954-432-9882
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374489201Medicaid
FLQ0536Medicare PIN
FLF75190Medicare UPIN