Provider Demographics
NPI:1316287485
Name:EHRENSTEIN, FRED IMRE (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:IMRE
Last Name:EHRENSTEIN
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 1:1110 S SOUTHLAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-1900
Mailing Address - Country:US
Mailing Address - Phone:954-609-5572
Mailing Address - Fax:
Practice Address - Street 1:1110 S SOUTHLAKE DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-1900
Practice Address - Country:US
Practice Address - Phone:954-609-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 23979208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)