Provider Demographics
NPI:1750408613
Name:REINERTSON, LAURA ELISE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELISE
Last Name:REINERTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21150 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1226
Mailing Address - Country:US
Mailing Address - Phone:305-932-8989
Mailing Address - Fax:305-932-1118
Practice Address - Street 1:21150 BISCAYNE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1226
Practice Address - Country:US
Practice Address - Phone:305-932-8989
Practice Address - Fax:305-932-1118
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78533174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256658300Medicaid
FL256658300Medicaid
FLG98984Medicare UPIN