Provider Demographics
NPI:1770556334
Name:DINENBERG, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:DINENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 WALDEMERE STREET
Mailing Address - Street 2:SUITE 609
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2913
Mailing Address - Country:US
Mailing Address - Phone:941-917-6500
Mailing Address - Fax:941-917-6504
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:SUITE 609
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2943
Practice Address - Country:US
Practice Address - Phone:941-917-6500
Practice Address - Fax:941-917-6504
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80369207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264813000Medicaid
FL1609826734OtherGROUP NPI
FL5296730001Medicare NSC
FL35516ZMedicare PIN
H20465Medicare UPIN