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Organization
REGINA B PORTNOVA MD INC
Active
Organization
REGINA B PORTNOVA MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STANISLAV PORTNOV (OFFICE DIRECTOR)
(954) 486-5700
Entity
Organization
Contact information
Practice address
2951 NW 49 AVE, SUITE 201, LAUDERDALE LAKES, FL 33313
(954) 486-5700
(954) 484-2574
Mailing address
2951 NW 49 AVE, SUITE 201, LAUDERDALE LAKES, FL 33313
(954) 486-5700
(954) 484-2574
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME 91789
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004877800
—
FL
05
—
271339000
—
FL
Enumeration date
07/14/2006
Last updated
10/26/2015
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