# MERIDIAN MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912815754
- **Authorized official:** STEPHAN DIMITRJEVITCH APRN, PMHNP (MANAGING MEMBER)
- **Authorized official phone:** (305) 396-1701

## Contact information

- **Practice address:** 9885 SW 123RD TERRACE, MIAMI, FL 33176
- **Practice address phone:** (305) 396-1701
- **Practice address fax:** (645) 231-2225
- **Mailing address:** 13818 SW 152ND ST \# 216, MIAMI, FL 33177-1164
- **Mailing address phone:** (305) 396-1701
- **Mailing address fax:** (645) 231-2225

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/01/2026
- **Last updated:** 09/01/2026