Provider Demographics
NPI:1972706729
Name:AVNI, FREDDY (MD)
Entity type:Individual
Prefix:DR
First Name:FREDDY
Middle Name:
Last Name:AVNI
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 1:1395 S STATE ROAD 7 STE 420
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9327
Mailing Address - Country:US
Mailing Address - Phone:561-204-4687
Mailing Address - Fax:561-204-4694
Practice Address - Street 1:1395 S STATE ROAD 7 STE 420
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9327
Practice Address - Country:US
Practice Address - Phone:561-204-4687
Practice Address - Fax:561-204-4694
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00068307207R00000X
FLME68307207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27766XMedicare ID - Type Unspecified
FLG04763Medicare UPIN