Provider Demographics
NPI:1285712125
Name:STEIN, ELLIOTT A (MD)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:A
Last Name:STEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21110 BISCAYNE BLVD
Mailing Address - Street 2:#404
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1227
Mailing Address - Country:US
Mailing Address - Phone:305-933-8966
Mailing Address - Fax:305-933-9238
Practice Address - Street 1:21110 BISCAYNE BLVD
Practice Address - Street 2:#404
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1227
Practice Address - Country:US
Practice Address - Phone:305-933-8966
Practice Address - Fax:305-933-9238
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 49870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260015447OtherMEDICARE RAILROAD
FL224802OtherAVMED
FL224802OtherAVMED
FL260015447OtherMEDICARE RAILROAD
FL05961Medicare ID - Type Unspecified