Healthcare Provider Details

I. General information

NPI: 1609830769
Provider Name (Legal Business Name): DUSHAN MARTINASEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33607-6308
US

IV. Provider business mailing address

3030 W DR M L KING JR BLVD
TAMPA FL
33607-3705
US

V. Phone/Fax

Practice location:
  • Phone: 813-872-2924
  • Fax: 813-879-4264
Mailing address:
  • Phone: 813-872-2924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME63462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: