MEDICARE: VEINCARE OF BREVARD, LLC

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	202K00000X	Phlebology Physician	ME 38276	FL

General Provider Information

NPI Number	:	1881972347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEINCARE OF BREVARD, LLC

Provider Business Mailing Address
First Line	:	2712 NEWFOUND HARBOR DR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-2866
Country	:	US
Telephone Number	:	321-961-2250
Fax Number	:

Provider Business Practice Location Address
First Line	:	2712 NEWFOUND HARBOR DR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-2866
Country	:	US
Telephone Number	:	321-961-2250
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. ROBERT MICHAEL STEVENS
Credential	:	MD
Telephone Number	:	321-961-2250

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	06/06/2014

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