Provider Demographics
NPI:1790824118
Name:STEPHEN WISE UNGER, M.D., P.A.
Entity Type:Organization
Organization Name:STEPHEN WISE UNGER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WISE
Authorized Official - Last Name:UNGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-532-4835
Mailing Address - Street 1:4302 ALTON RD
Mailing Address - Street 2:SUITE 720
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2877
Mailing Address - Country:US
Mailing Address - Phone:305-532-4835
Mailing Address - Fax:305-532-0662
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 720
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2877
Practice Address - Country:US
Practice Address - Phone:305-532-4835
Practice Address - Fax:305-532-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259273800Medicaid
FL259273800Medicaid