Basic Information
| Provider Information | |||||||||
| NPI: | 1396062337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUSKOVICH | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 293 NW PEACOCK BLVD STE 204 | ||||||||
| Address2: | |||||||||
| City: | PORT ST LUCIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349862222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7728794667 | ||||||||
| FaxNumber: | 7728794478 | ||||||||
| Practice Location | |||||||||
| Address1: | 293 NW PEACOCK BLVD STE 204 | ||||||||
| Address2: | |||||||||
| City: | PORT ST LUCIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349862222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7728794667 | ||||||||
| FaxNumber: | 7728794478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2010 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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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 | ME123515 | FL | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.