Provider Demographics
NPI:1407811235
Name:STEIN, JEANNINE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:MARIE
Last Name:STEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JEANNINE
Other - Middle Name:MARIE
Other - Last Name:STEIN-MCCLATCHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8057 SPYGLASS HILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8565
Mailing Address - Country:US
Mailing Address - Phone:321-428-4545
Mailing Address - Fax:321-421-7898
Practice Address - Street 1:7960 N WICKHAM RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-428-4545
Practice Address - Fax:321-421-7898
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88079207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280413100Medicaid
FL82885YMedicare PIN
FL280413100Medicaid