Provider Demographics
NPI:1396733572
Name:BEREND, IVAN A (MD)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:A
Last Name:BEREND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:975 ARTHUR GODFREY RD
Mailing Address - Street 2:SUITE 408
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3329
Mailing Address - Country:US
Mailing Address - Phone:305-538-8660
Mailing Address - Fax:305-538-8667
Practice Address - Street 1:21097 NE 27TH CT
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1245
Practice Address - Country:US
Practice Address - Phone:305-538-8660
Practice Address - Fax:305-538-8667
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2007-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME79620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6696XMedicare PIN
H53126Medicare UPIN