Basic Information
| Provider Information | |||||||||
| NPI: | 1235244807 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEIN | ||||||||
| FirstName: | MARVIN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4515 WILES RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | COCONUT CREEK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330733414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549431133 | ||||||||
| FaxNumber: | 9547836845 | ||||||||
| Practice Location | |||||||||
| Address1: | 4515 WILES RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | COCONUT CREEK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330733414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549431133 | ||||||||
| FaxNumber: | 9547836845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | ME 33072 | FL | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | P947776 | 01 | FL | OPTIMUM | OTHER | 250662 | 01 | FL | AVMED | OTHER | 0597919 | 01 | FL | CIGNA | OTHER | 4068200 | 01 | FL | AETNA | OTHER | P01609953 | 01 | FL | RR MEDICARE | OTHER | 2693 | 01 | FL | DIMENSIONS | OTHER | 93720 | 01 | FL | BCBS | OTHER | P00965 | 01 | FL | FREEDOM | OTHER |