Healthcare Provider Details

I. General information

NPI: 1902197973
Provider Name (Legal Business Name): MAX ALLEN MONDESTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 JOHN F KENNEDY DR STE 100
ATLANTIS FL
33462-6641
US

IV. Provider business mailing address

180 JOHN F KENNEDY DR STE 100
ATLANTIS FL
33462-6641
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-6500
  • Fax: 561-433-4175
Mailing address:
  • Phone: 561-967-6500
  • Fax: 561-433-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME150173
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD83420
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: