Provider Demographics
NPI:1467450874
Name:PRESUTTI, RICHARD ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ANTHONY
Last Name:PRESUTTI
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 1:11424 OHANU CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-7031
Mailing Address - Country:US
Mailing Address - Phone:954-752-8446
Mailing Address - Fax:954-752-8464
Practice Address - Street 1:9750 NW 33RD ST
Practice Address - Street 2:#216
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4042
Practice Address - Country:US
Practice Address - Phone:954-752-8446
Practice Address - Fax:954-752-8464
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME22496208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93150OtherBC/BS
FL035451100Medicaid
FL035451100Medicaid