Healthcare Provider Details

I. General information

NPI: 1144219304
Provider Name (Legal Business Name): STACY ZIDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY ZIMMERMAN MD

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 NE MIAMI GARDENS DR
NORTH MIAMI BEACH FL
33179-4900
US

IV. Provider business mailing address

900 S PINE ISLAND RD SUITE 800
PLANTATION FL
33324-3920
US

V. Phone/Fax

Practice location:
  • Phone: 305-940-6001
  • Fax: 305-940-6016
Mailing address:
  • Phone: 305-940-6016
  • Fax: 305-940-6167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME88087
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: