Provider Demographics
NPI:1346570041
Name:INDIALANTIC MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:INDIALANTIC MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEMBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-724-9900
Mailing Address - Street 1:152 ISLAND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4346
Mailing Address - Country:US
Mailing Address - Phone:321-724-9900
Mailing Address - Fax:
Practice Address - Street 1:408 5TH AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4280
Practice Address - Country:US
Practice Address - Phone:321-724-9900
Practice Address - Fax:321-724-6609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63923208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty