Active NPI
Michael Sonenblum, MD
- Pediatrics Physician
- Port St Lucie, FL
National Provider Identifier
1275522690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME57821
- Practice address
- 1850 SW Fountainview Blvd
Suite 105
Port St Lucie, FL 34986-3443 - Phone
- (772) 336-2818
- Fax
- (772) 336-5313
- NPI assigned
- Oct 18, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME57821 | FL | Primary |
Addresses
Primary practice location
1850 SW Fountainview Blvd
Suite 105
Port St Lucie, FL 34986-3443
Mailing address
900 S Pine Island Rd
Ste 800
Plantation, FL 33324-3920
Phone (772) 336-2818
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 064614800 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME57821 | FL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381276800000",
"number": "1275522690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 S PINE ISLAND RD",
"address_2": "STE 800",
"city": "PLANTATION",
"state": "FL",
"postal_code": "333243920",
"telephone_number": "772-336-2818",
"fax_number": "772-336-5313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1850 SW FOUNTAINVIEW BLVD",
"address_2": "SUITE 105",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349863443",
"telephone_number": "772-336-2818",
"fax_number": "772-336-5313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONENBLUM",
"first_name": "MICHAEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-18",
"last_updated": "2013-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME57821",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "064614800",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.