Healthcare Provider Details

I. General information

NPI: 1649846379
Provider Name (Legal Business Name): MILES BLATSTEIN M.H.SC., CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 08/24/2024
Certification Date: 08/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N STATE ROAD 7
MARAGE FL
33063-5727
US

IV. Provider business mailing address

2801 N STATE ROAD 7
MARGATE FL
33063-5727
US

V. Phone/Fax

Practice location:
  • Phone: 954-974-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number11503
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA661
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: