MEDICARE: DR. MITCHELL E SPERO PSY D

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
1	103TC0700X	Clinical Psychologist	PYH4098	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	73376	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699756635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL E SPERO PSY D

Provider Business Mailing Address
First Line	:	350 NW 70TH AVE
Second Line	:	STE A
City	:	PLANTATION
State	:	FL
Zip	:	33317-2349
Country	:	US
Telephone Number	:	954-587-7520
Fax Number	:	954-587-7527

Provider Business Practice Location Address
First Line	:	350 NW 70TH AVE
Second Line	:	STE A
City	:	PLANTATION
State	:	FL
Zip	:	33317-2349
Country	:	US
Telephone Number	:	954-587-7520
Fax Number	:	954-587-7527

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	08/20/2007

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