Provider Demographics
NPI:1891743365
Name:CORREDERA, WILFREDO (MD)
Entity type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:CORREDERA
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:113 HEALTH WAY
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-4716
Practice Address - Country:US
Practice Address - Phone:634-657-0108
Practice Address - Fax:863-465-4223
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18577OtherBLUE CROSS
FL372499900Medicaid
FL372499900Medicaid
FL18577XMedicare PIN
FL18577Medicare PIN
FL18577WMedicare PIN
FL18577YMedicare PIN
FL18577OtherBLUE CROSS