Provider Demographics
NPI:1851489066
Name:GIBSTEIN, LEE A (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:A
Last Name:GIBSTEIN
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 KANE CONCOURSE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2029
Mailing Address - Country:US
Mailing Address - Phone:305-865-2802
Mailing Address - Fax:305-865-9257
Practice Address - Street 1:1111 KANE CONCOURSE
Practice Address - Street 2:SUITE 311
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2029
Practice Address - Country:US
Practice Address - Phone:305-865-2802
Practice Address - Fax:305-865-9257
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG35136Medicare UPIN
FL38030Medicare ID - Type Unspecified