Healthcare Provider Details

I. General information

NPI: 1174526255
Provider Name (Legal Business Name): STEPHEN SCHOENBAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

9050 PINES BLVD STE 200
PEMBROKE PINES FL
33024-6456
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-2000
  • Fax: 954-437-6628
Mailing address:
  • Phone: 954-437-4800
  • Fax: 954-437-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME67978
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: