Provider Demographics
NPI:1396062337
Name:MUSKOVICH, JUSTIN ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ANDREW
Last Name:MUSKOVICH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:293 NW PEACOCK BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2222
Mailing Address - Country:US
Mailing Address - Phone:772-879-4667
Mailing Address - Fax:772-879-4478
Practice Address - Street 1:293 NW PEACOCK BLVD STE 204
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2222
Practice Address - Country:US
Practice Address - Phone:772-879-4667
Practice Address - Fax:772-879-4478
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME123515208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology