MEDICARE: DAVID SONTAG A.P., D.O.M.

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	133N00000X	Nutritionist	NC575	FL
2	171100000X	Acupuncturist	AP845	FL

General Provider Information

NPI Number	:	1760506778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID SONTAG A.P., D.O.M.

Provider Business Mailing Address
First Line	:	4000 TOWERSIDE TER APT 1207
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2239
Country	:	US
Telephone Number	:	305-891-3444
Fax Number	:	305-895-1877

Provider Business Practice Location Address
First Line	:	18110 NE 19TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-1606
Country	:	US
Telephone Number	:	305-949-2990
Fax Number	:	305-949-2980

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	01/03/2019

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