=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972765329
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER MENNIE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2008
-----------------------------------------------------
Last Update Date | 10/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9299 SW 152ND ST STE 104
-----------------------------------------------------
City | PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-1775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-925-8118
-----------------------------------------------------
Fax | 305-925-8119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8669 NW 36TH ST STE 325
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166-6698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-925-8118
-----------------------------------------------------
Fax | 305-925-8119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | ME115374
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------