Healthcare Provider Details

I. General information

NPI: 1942287966
Provider Name (Legal Business Name): MARIO MARTINASEVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 01/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8251 W BROWARD BLVD SUITE 300
PLANTATION FL
33324-2703
US

IV. Provider business mailing address

8251 W BROWARD BLVD SUITE 300
PLANTATION FL
33324-2703
US

V. Phone/Fax

Practice location:
  • Phone: 954-475-9535
  • Fax: 954-475-4637
Mailing address:
  • Phone: 954-475-9535
  • Fax: 954-475-4637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME 87353
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: