MEDICARE: MR. JOSEPH MICHAEL MASCENIK P.A.-C

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	363AM0700X	Medical Physician Assistant	PA9103525	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	:	1982870606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH MICHAEL MASCENIK P.A.-C

Provider Business Mailing Address
First Line	:	12458 SW 44TH CT
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-6004
Country	:	US
Telephone Number	:	954-937-7887
Fax Number	:

Provider Business Practice Location Address
First Line	:	7050 TAFT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-3804
Country	:	US
Telephone Number	:	954-399-9014
Fax Number	:

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

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	04/06/2023

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