Provider Demographics
NPI:1013000769
Name:MLNARIK, JASON M (DO)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:MLNARIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 TAMIAMI TRL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1018
Mailing Address - Country:US
Mailing Address - Phone:941-629-6262
Mailing Address - Fax:941-629-1782
Practice Address - Street 1:1641 TAMIAMI TRL
Practice Address - Street 2:SUITE 1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1018
Practice Address - Country:US
Practice Address - Phone:941-629-6262
Practice Address - Fax:941-629-1782
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006022623207X00000X, 207XX0801X
FLOS14041207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIT309ZMedicare PIN
MOP00458217Medicare PIN
MOI65655Medicare UPIN
KS200418860AMedicaid
MOP00458217Medicare PIN