Provider Demographics
NPI:1992735039
Name:LENZ, OLIVER (MD)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:
Last Name:LENZ
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 1:1120 NW 14TH STREET
Mailing Address - Street 2:ROOM 360 R
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:305-243-3583
Mailing Address - Fax:305-243-3506
Practice Address - Street 1:1120 NW 14TH STREET
Practice Address - Street 2:ROOM 360 R
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-243-3583
Practice Address - Fax:305-243-3506
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83735207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2648199-00Medicaid
H66963Medicare UPIN
17489Medicare ID - Type Unspecified