Provider Demographics
NPI:1629429261
Name:HENRIQUEZ, ANDRES FIDEL (MD)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:FIDEL
Last Name:HENRIQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10796 PINES BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3919
Mailing Address - Country:US
Mailing Address - Phone:954-442-1402
Mailing Address - Fax:954-442-1418
Practice Address - Street 1:10796 PINES BLVD STE 103
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3919
Practice Address - Country:US
Practice Address - Phone:954-442-1402
Practice Address - Fax:954-442-1418
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.068235207R00000X
MN65589207RE0101X
FLME156949207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine