Provider Demographics
NPI:1306826037
Name:GREEN, STEFANI M (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFANI
Middle Name:M
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12302 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5514
Mailing Address - Country:US
Mailing Address - Phone:305-893-7698
Mailing Address - Fax:305-893-7917
Practice Address - Street 1:12302 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5514
Practice Address - Country:US
Practice Address - Phone:305-893-7698
Practice Address - Fax:305-893-7917
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME81809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271260OtherWELLCARE
FL42258OtherNEIGHBORHOOD HEALTH PARTN
FLM818091OtherPMP/ MEDICAID
FLSG076471OtherVISTA HEALTH PLAN
FL267405OtherAMERIGROUP
FL05038OtherBLUE CROSS BLUE SHIELD
FL179742OtherJMH HEALTH PLAN
FL107076OtherHUMANA
FL7654296OtherAETNA
FL2473548OtherUNITED HELTH CARE
FL6652172OtherCIGNA
FLAETNAOtherAVMED
FL1200802OtherUHC/MDCIAD/HEALTHY KIDS
FL534/382OtherPMP/ COMMERCIAL
FL7654296OtherAETNA