Provider Demographics
NPI:1700988136
Name:LORENTZ, WLADIMIR PIZZUTO (MD)
Entity type:Individual
Prefix:
First Name:WLADIMIR
Middle Name:PIZZUTO
Last Name:LORENTZ
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 1:15805 BISCAYNE BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-5378
Mailing Address - Country:US
Mailing Address - Phone:786-360-6315
Mailing Address - Fax:786-360-6473
Practice Address - Street 1:15805 BISCAYNE BLVD STE 211
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-5378
Practice Address - Country:US
Practice Address - Phone:786-360-6315
Practice Address - Fax:786-360-6473
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME008932208000000X
FLME80932208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51601OtherBLUE CROSS BLUE SHIELD
1209013OtherHUMANAS CHOICE CARE
1207337OtherUNITED HEALTHCARE
FL7477241OtherAETNA
7697371OtherCIGNA
51601ZMedicare PIN
FL171309OtherWELLCARE PFFS
FL651021041OtherHUMANA
FL171309OtherSTAYWELL HEALTH PLAN
FL037682OtherNHP
FL277305OtherAVMED
FL277305OtherAVMED PMMI
FL000810168714OtherPCHS
FL114420OtherAMERIGROUP
FL171309OtherWELLCARE