Provider Demographics
NPI:1972765329
Name:MENNIE, PETER (MD)
Entity Type:Individual
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First Name:PETER
Middle Name:
Last Name:MENNIE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7300 N KENDALL DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7840
Mailing Address - Country:US
Mailing Address - Phone:305-925-8118
Mailing Address - Fax:305-925-8119
Practice Address - Street 1:9299 SW 152ND ST STE 104
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1775
Practice Address - Country:US
Practice Address - Phone:305-925-8118
Practice Address - Fax:305-925-8119
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2021-04-20
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Provider Licenses
StateLicense IDTaxonomies
FLME115374208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHM730ZMedicare UPIN