Healthcare Provider Details

I. General information

NPI: 1720068299
Provider Name (Legal Business Name): STEVEN MEDNICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 SW 152ND ST
VILLAGE OF PALMETTO BAY FL
33157-1778
US

IV. Provider business mailing address

9333 SW 152ND ST
VILLAGE OF PALMETTO BAY FL
33157-1778
US

V. Phone/Fax

Practice location:
  • Phone: 305-256-5001
  • Fax: 561-852-1985
Mailing address:
  • Phone: 305-256-5001
  • Fax: 561-852-1985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME0060361
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: