Healthcare Provider Details

I. General information

NPI: 1568758449
Provider Name (Legal Business Name): MARK STERN, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MACDILL AVE SUITE 100
TAMPA FL
33609-3131
US

IV. Provider business mailing address

7200 CORPORATE CENTER DR SUITE 600
MIAMI FL
33126-1200
US

V. Phone/Fax

Practice location:
  • Phone: 813-837-2814
  • Fax: 813-839-4336
Mailing address:
  • Phone: 305-500-2000
  • Fax: 305-500-2145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberME33074
License Number StateFL

VIII. Authorized Official

Name: HOLLY LOPEZ
Title or Position: VP, SUPPORT SERVICES
Credential:
Phone: 305-500-2108