MEDICARE: DR. JUSTIN ANDREW MUSKOVICH M.D.

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	208800000X	Urology Physician	ME123515	FL

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	:	1396062337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN ANDREW MUSKOVICH M.D.

Provider Business Mailing Address
First Line	:	293 NW PEACOCK BLVD STE 204
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-2222
Country	:	US
Telephone Number	:	772-879-4667
Fax Number	:	772-879-4478

Provider Business Practice Location Address
First Line	:	293 NW PEACOCK BLVD STE 204
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-2222
Country	:	US
Telephone Number	:	772-879-4667
Fax Number	:	772-879-4478

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

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	02/09/2022

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