Healthcare Provider Details

I. General information

NPI: 1730682642
Provider Name (Legal Business Name): CENTENNIAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 BEDFORD DRIVE
MELBOURNE FL
32940
US

IV. Provider business mailing address

1341 BEDFORD DRIVE
MELBOURNE FL
32940
US

V. Phone/Fax

Practice location:
  • Phone: 321-622-8031
  • Fax: 321-610-7487
Mailing address:
  • Phone: 321-622-8031
  • Fax: 321-610-7487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN M GIORGIANNI
Title or Position: OWNER
Credential: DO
Phone: 321-622-8031