Healthcare Provider Details

I. General information

NPI: 1326041344
Provider Name (Legal Business Name): MITCHELL BRIAN LOWENSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32615 US HIGHWAY 19 N STE 2
PALM HARBOR FL
34684-3176
US

IV. Provider business mailing address

32615 US HIGHWAY 19 N STE 2
PALM HARBOR FL
34684-3176
US

V. Phone/Fax

Practice location:
  • Phone: 727-789-2784
  • Fax: 727-785-3537
Mailing address:
  • Phone: 727-789-2784
  • Fax: 727-785-3537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0031700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: