Provider Demographics
NPI:1891738720
Name:HENRIQUEZ, FIDEL H (MD)
Entity type:Individual
Prefix:
First Name:FIDEL
Middle Name:H
Last Name:HENRIQUEZ
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 1:10796 PINES BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3905
Mailing Address - Country:US
Mailing Address - Phone:954-442-1402
Mailing Address - Fax:954-442-1418
Practice Address - Street 1:10796 PINES BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3905
Practice Address - Country:US
Practice Address - Phone:954-442-1402
Practice Address - Fax:954-442-1418
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058002207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0058002OtherLICENSE
E37137Medicare UPIN
FL10872AMedicare ID - Type Unspecified