Basic Information
Provider Information
NPI: 1326001280
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KOBETZ
FirstName: STEVEN
MiddleName: ALLEN
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 160010
Address2:  
City: HIALEAH
State: FL
PostalCode: 330160001
CountryCode: US
TelephoneNumber: 7869241311
FaxNumber: 7869241313
Practice Location
Address1: 8940 N KENDALL DR
Address2: 802E
City: MIAMI
State: FL
PostalCode: 331762148
CountryCode: US
TelephoneNumber: 3055954041
FaxNumber: 3055956638
Other Information
ProviderEnumerationDate: 04/10/2006
LastUpdateDate: 03/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/25/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400XME26985FLY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


Home