Provider Demographics
NPI:1811994528
Name:BERGER, RENATO AUGUSTO (MD, FAAP)
Entity type:Individual
Prefix:DR
First Name:RENATO
Middle Name:AUGUSTO
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 NE 22ND TER
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2613
Mailing Address - Country:US
Mailing Address - Phone:954-794-1360
Mailing Address - Fax:954-794-1367
Practice Address - Street 1:5300 W HILLSBORO BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4395
Practice Address - Country:US
Practice Address - Phone:954-794-1360
Practice Address - Fax:954-794-1367
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 80792208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003725700Medicaid