Healthcare Provider Details

I. General information

NPI: 1902010697
Provider Name (Legal Business Name): IRA M. STEIN, M.D., L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13005 SOUTHERN BLVD BUILDING 1, SUITE 124
LOXAHATCHEE FL
33470-9206
US

IV. Provider business mailing address

13005 SOUTHERN BLVD BUILDING 1, SUITE 124
LOXAHATCHEE FL
33470-9206
US

V. Phone/Fax

Practice location:
  • Phone: 561-204-4240
  • Fax: 561-204-4242
Mailing address:
  • Phone: 561-204-4240
  • Fax: 561-204-4242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberME0078470
License Number StateFL

VIII. Authorized Official

Name: DR. IRA MICHAEL STEIN
Title or Position: MANAGER
Credential: M.D.
Phone: 561-204-4240