Provider Demographics
NPI:1942287966
Name:MARTINASEVIC, MARIO (MD)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
Last Name:MARTINASEVIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8251 W BROWARD BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2703
Mailing Address - Country:US
Mailing Address - Phone:954-475-9535
Mailing Address - Fax:954-475-4637
Practice Address - Street 1:8251 W BROWARD BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2703
Practice Address - Country:US
Practice Address - Phone:954-475-9535
Practice Address - Fax:954-475-4637
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 873532086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78641ZMedicare PIN
H48440Medicare UPIN