Provider Demographics
NPI:1811906761
Name:RONALD N REIS MD PA
Entity type:Organization
Organization Name:RONALD N REIS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:N
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-740-0484
Mailing Address - Street 1:5757 MICHELANGELO ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2632
Mailing Address - Country:US
Mailing Address - Phone:305-740-0484
Mailing Address - Fax:305-740-3479
Practice Address - Street 1:2601 SW 37TH AVE
Practice Address - Street 2:STE 702
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2700
Practice Address - Country:US
Practice Address - Phone:305-445-1221
Practice Address - Fax:305-648-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM364313208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250309300Medicaid
FLFB926AOtherMEDICARE PTAN
FL250309300Medicaid