MEDICARE: MARK STERN, 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	332900000X	Non-Pharmacy Dispensing Site	ME33074	FL

General Provider Information

NPI Number	:	1568758449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK STERN, MD

Provider Business Mailing Address
First Line	:	7200 CORPORATE CENTER DR
Second Line	:	SUITE 600
City	:	MIAMI
State	:	FL
Zip	:	33126-1200
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:	305-500-2145

Provider Business Practice Location Address
First Line	:	200 S MACDILL AVE
Second Line	:	SUITE 100
City	:	TAMPA
State	:	FL
Zip	:	33609-3131
Country	:	US
Telephone Number	:	813-837-2814
Fax Number	:	813-839-4336

Authorized Official
Title or Position	:	VP, SUPPORT SERVICES
Name	:	HOLLY LOPEZ
Credential	:
Telephone Number	:	305-500-2108

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	10/27/2011

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