Provider Demographics
NPI:1528208915
Name:MEDINA, ANITA JANINE (DO)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:JANINE
Last Name:MEDINA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13087 SW 197TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-4807
Mailing Address - Country:US
Mailing Address - Phone:305-773-7411
Mailing Address - Fax:
Practice Address - Street 1:13087 SW 197TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-4807
Practice Address - Country:US
Practice Address - Phone:305-773-7411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11420208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS11420OtherFLORIDA MEDICAL LICENSE