Provider Demographics
NPI:1831195916
Name:REHNKE, ERNEST C (MD)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:C
Last Name:REHNKE
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 1:780 94TH AVE N STE 112
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2468
Mailing Address - Country:US
Mailing Address - Phone:727-344-0640
Mailing Address - Fax:727-344-0669
Practice Address - Street 1:780 94TH AVE N STE 112
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2468
Practice Address - Country:US
Practice Address - Phone:727-344-0640
Practice Address - Fax:727-344-0669
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041586208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD20918Medicare UPIN
FL04334AMedicare ID - Type Unspecified