Provider Demographics
NPI:1720001191
Name:AVENTURA ENDOCRINE ASSOCIATES PA
Entity Type:Organization
Organization Name:AVENTURA ENDOCRINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:THALER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-937-3000
Mailing Address - Street 1:2801 NE 213TH ST STE 1015
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1266
Mailing Address - Country:US
Mailing Address - Phone:305-937-3000
Mailing Address - Fax:888-268-0675
Practice Address - Street 1:2801 NE 213TH ST STE 1015
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1266
Practice Address - Country:US
Practice Address - Phone:305-937-3000
Practice Address - Fax:888-268-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0686Medicare ID - Type UnspecifiedGROUP NUMBER