Provider Demographics
NPI:1174716799
Name:PENTZKE, ISIDRO GUILLERMO (MD)
Entity type:Individual
Prefix:DR
First Name:ISIDRO
Middle Name:GUILLERMO
Last Name:PENTZKE
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 1:6309 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-4328
Mailing Address - Country:US
Mailing Address - Phone:561-585-0640
Mailing Address - Fax:561-585-0659
Practice Address - Street 1:6309 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-4328
Practice Address - Country:US
Practice Address - Phone:561-585-0640
Practice Address - Fax:561-585-0659
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM67383208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF95915Medicare UPIN