Provider Demographics
NPI:1851322341
Name:PANSEONAT MIRACLE LLC
Entity Type:Organization
Organization Name:PANSEONAT MIRACLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DORIT
Authorized Official - Middle Name:
Authorized Official - Last Name:YABROV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-484-9730
Mailing Address - Street 1:5400 BISCAYNE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-0000
Mailing Address - Country:US
Mailing Address - Phone:877-387-1777
Mailing Address - Fax:
Practice Address - Street 1:5400 BISCAYNE DR
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-0000
Practice Address - Country:US
Practice Address - Phone:877-387-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 93717207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty