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General NPI Number Information
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NPI Number | 1942287966
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Entity Type | Individual
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Provider Name | MARIO MARTINASEVIC MD
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Gender | Male
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 8251 W BROWARD BLVD SUITE 300
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City | PLANTATION
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State | FL
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Zip | 33324-2703
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Country | US
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Telephone | 954-475-9535
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Fax | 954-475-4637
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Provider Business Mailing Address
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Address Line | 8251 W BROWARD BLVD SUITE 300
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City | PLANTATION
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State | FL
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Zip | 33324-2703
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Country | US
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Telephone | 954-475-9535
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Fax | 954-475-4637
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | ME 87353
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License Number State | FL
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