Provider Demographics
NPI:1871767426
Name:PHILIP, RENGIT (MD)
Entity type:Individual
Prefix:
First Name:RENGIT
Middle Name:
Last Name:PHILIP
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 1:4315 HIGHLAND PARK BLVD, SUITE D,
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813
Mailing Address - Country:US
Mailing Address - Phone:863-816-5884
Mailing Address - Fax:863-940-4856
Practice Address - Street 1:4315 HIGHLAND PARK BLVD, SUITE D,
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813
Practice Address - Country:US
Practice Address - Phone:863-816-5884
Practice Address - Fax:863-940-4856
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL407365Medicaid
FL407365Medicaid