Provider Demographics
NPI:1235244807
Name:STEIN, MARVIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:L
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 1:4515 WILES RD STE 201
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3414
Mailing Address - Country:US
Mailing Address - Phone:954-943-1133
Mailing Address - Fax:954-783-6845
Practice Address - Street 1:4515 WILES RD STE 201
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3414
Practice Address - Country:US
Practice Address - Phone:954-943-1133
Practice Address - Fax:954-783-6845
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 33072208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP947776OtherOPTIMUM
FL250662OtherAVMED
FL0597919OtherCIGNA
FL4068200OtherAETNA
FLP01609953OtherRR MEDICARE
FL2693OtherDIMENSIONS
FL93720OtherBCBS
FLP00965OtherFREEDOM
FLP01609953OtherRR MEDICARE
FL93720UMedicare PIN
FL93720OtherBCBS