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NPI Code Detail

MEDICARE: DR. JOSEPH STAGGENBORG MD

MEDICARE: DR. JOSEPH STAGGENBORG MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician55500TN
2207L00000XAnesthesiology Physician036086326IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1036086326OTHERILBC OF IL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669451134
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSEPH STAGGENBORG MD
Provider Business Mailing Address
First Line : 5000 W OAKLAND PARK BLVD
Second Line :
City : LAUDERDALE LAKES
State : FL
Zip : 33313-1503
Country : US
Telephone Number : 954-735-6000
Fax Number :
Provider Business Practice Location Address
First Line : 5000 W OAKLAND PARK BLVD
Second Line :
City : LAUDERDALE LAKES
State : FL
Zip : 33313-1503
Country : US
Telephone Number : 954-735-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2006
Last Update Date : 09/11/2024

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Directions to “ DR. JOSEPH STAGGENBORG MD” Practice Location

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