Basic Information
| Provider Information | |||||||||
| NPI: | 1689630592 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GELRUD | ||||||||
| FirstName: | ANDRES | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 S DADELAND BLVD | ||||||||
| Address2: | 200 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331562866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054684185 | ||||||||
| FaxNumber: | 3056753378 | ||||||||
| Practice Location | |||||||||
| Address1: | 8200 SW 117TH AVE | ||||||||
| Address2: | 110 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331834825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052745500 | ||||||||
| FaxNumber: | 3052745512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME131069 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 2478724 | 05 | OH | MEDICAID | P00124490 | 01 | OH | RAIL ROAD MEDICARE | OTHER | 200302230 | 05 | IN | MEDICAID | ME131069 | 01 | FL | FLORIDA DEPARTMENT OF HEALTH | OTHER | 4047831 | 05 | TN | MEDICAID | 64078728 | 05 | KY | MEDICAID |