Provider Demographics
NPI:1306975305
Name:RZADKOWOLSKI RAOLI, CESARE (MD)
Entity type:Individual
Prefix:
First Name:CESARE
Middle Name:
Last Name:RZADKOWOLSKI RAOLI
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 1:2001 NW 7TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3479
Mailing Address - Country:US
Mailing Address - Phone:305-631-0202
Mailing Address - Fax:305-668-6277
Practice Address - Street 1:12315 SW 64TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-5538
Practice Address - Country:US
Practice Address - Phone:305-631-0202
Practice Address - Fax:305-668-6277
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME604152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME60415OtherSTATE LICENSE NUMBER
FL14460OtherBCBS PROVIDER NUMBER
FL14460BMedicare PIN
FLME60415OtherSTATE LICENSE NUMBER