Provider Demographics
NPI:1073500484
Name:SANDBERG, JOEL (MD)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:
Last Name:SANDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOEL
Other - Middle Name:
Other - Last Name:SANDBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:300 S PARK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8353
Mailing Address - Country:US
Mailing Address - Phone:954-925-2740
Mailing Address - Fax:954-923-8379
Practice Address - Street 1:300 S PARK RD STE 300
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8353
Practice Address - Country:US
Practice Address - Phone:954-925-2740
Practice Address - Fax:954-923-8379
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0024544207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035382500Medicaid
FLD60332Medicare UPIN
FL035382500Medicaid