MEDICARE: BRANDON LOUIS MEDNICK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	056138	GA
2	207P00000X	Emergency Medicine Physician	01098122A	IN
3	207P00000X	Emergency Medicine Physician	96106	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205925237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON LOUIS MEDNICK MD

Provider Business Mailing Address
First Line	:	18167 US HIGHWAY 19 N STE 650
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33764-6576
Country	:	US
Telephone Number	:	800-507-8874
Fax Number	:	727-507-3618

Provider Business Practice Location Address
First Line	:	18167 US HWY 19 NORTH
Second Line	:	SUITE 650
City	:	CLEARWATER
State	:	FL
Zip	:	33764-9843
Country	:	US
Telephone Number	:	727-507-3643
Fax Number	:	727-507-3618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	12/30/2025

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Directions to “ BRANDON LOUIS MEDNICK MD” Practice Location

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