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General NPI Number Information
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NPI Number | 1457591828
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Entity Type | Organization
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Legal Business Name | MEDICINE MAN PAIN MANAGEMENT CENTER
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 02/25/2009
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Provider Practice Location Address
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Address Line | 14471 S DIXIE HWY
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City | MIAMI
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State | FL
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Zip | 33176-7924
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Country | US
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Telephone | 786-573-4777
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Fax | 786-573-4887
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Provider Business Mailing Address
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Address Line | 14471 S DIXIE HWY
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City | MIAMI
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State | FL
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Zip | 33176-7924
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Country | US
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Telephone | 786-573-4777
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Fax | 786-573-4887
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. STANLEY SEZHI YUAN
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Credential | A.P.
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Telephone | 786-573-4777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | AP 1607
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License Number State | FL
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