MEDICARE: DR. JOHN BRENNAN STOCKEL M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085N0700X	Neuroradiology Physician	221093	NY
2	2085N0700X	Neuroradiology Physician	0101229014	VA
3	2085N0700X	Neuroradiology Physician	ME83053	FL
4	2085N0700X	Neuroradiology Physician	42151	CO
5	2085N0700X	Neuroradiology Physician	AFE45310	CA
6	2085N0700X	Neuroradiology Physician	C10005885	DE
7	2085N0700X	Neuroradiology Physician	M7656	TX
8	2085N0700X	Neuroradiology Physician	MD072116L	PA
9	2085N0700X	Neuroradiology Physician	35077791S	OH
10	2085N0700X	Neuroradiology Physician	D0045541	MD
11	2085R0202X	Diagnostic Radiology Physician	ME83053	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P02028187	OTHER	FL	FLORIDA RAILROAD MEDICARE
3	HR328X	OTHER	FL	FLORIDA MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	10434355	OTHER	FL	CAQH
4	96JV5	OTHER	FL	FLORIDA BLUE (BCBS)
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1609877067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN BRENNAN STOCKEL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7623
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34101-7623
Country	:	US
Telephone Number	:	305-712-7229
Fax Number	:	305-397-1139

Provider Business Practice Location Address
First Line	:	3663 S MIAMI AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-4253
Country	:	US
Telephone Number	:	305-854-4400
Fax Number	:

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/05/2022

701 NW 27TH AVE
MIAMI, FL
33125-3012

Practice Phone: 786-744-1900
Practice Fax: 305-760-4141