Provider Demographics
NPI:1265625701
Name:CORRALES REYES, ENME G (MD)
Entity type:Individual
Prefix:
First Name:ENME
Middle Name:G
Last Name:CORRALES REYES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9960 NW 116TH WAY STE 13
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1175
Mailing Address - Country:US
Mailing Address - Phone:786-924-1311
Mailing Address - Fax:786-924-1313
Practice Address - Street 1:14201 W SUNRISE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3207
Practice Address - Country:US
Practice Address - Phone:954-686-7057
Practice Address - Fax:954-218-5077
Is Sole Proprietor?:No
Enumeration Date:2007-08-18
Last Update Date:2024-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME1087442084N0402X, 2084E0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003721000Medicaid
FLGP426ZMedicare PIN