Provider Demographics
NPI:1922028463
Name:STUART K JOSEPH MD., LLC
Entity Type:Organization
Organization Name:STUART K JOSEPH MD., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-233-5760
Mailing Address - Street 1:9299 SW 152ND ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1775
Mailing Address - Country:US
Mailing Address - Phone:305-233-5760
Mailing Address - Fax:305-238-1517
Practice Address - Street 1:9299 SW 152ND ST
Practice Address - Street 2:SUITE 104
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1775
Practice Address - Country:US
Practice Address - Phone:305-233-5760
Practice Address - Fax:305-238-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54779174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035576300Medicaid
FL035576300Medicaid
FLK3668Medicare PIN