Provider Demographics
NPI:1992149355
Name:GRUDSKY, FELIX
Entity type:Individual
Prefix:
First Name:FELIX
Middle Name:
Last Name:GRUDSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 NE 213TH ST STE 101100
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1263
Mailing Address - Country:US
Mailing Address - Phone:305-466-7333
Mailing Address - Fax:786-651-2177
Practice Address - Street 1:2801 NE 213TH ST STE 101100
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1263
Practice Address - Country:US
Practice Address - Phone:305-466-7333
Practice Address - Fax:786-651-2177
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17040207R00000X
FLUO3356207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine