Provider Demographics
NPI:1396799383
Name:ONDRUSEK, JAROSLAV F (MD)
Entity type:Individual
Prefix:
First Name:JAROSLAV
Middle Name:F
Last Name:ONDRUSEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:F
Other - Last Name:ONDRUSEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2598 NW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3654
Mailing Address - Country:US
Mailing Address - Phone:954-303-3750
Mailing Address - Fax:954-343-1016
Practice Address - Street 1:2817 EAST OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1889
Practice Address - Country:US
Practice Address - Phone:954-302-3750
Practice Address - Fax:954-343-1016
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69418207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379380000Medicaid
28222YMedicare PIN
FLF75755Medicare UPIN
FL379380000Medicaid