Organization
COASTLINE MEDICAL SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL TAVERNARIS M.D (PHYSICIAN)
(850) 396-1110
Entity
Organization
Contact information
Practice address
1817 LEWIS TURNER BLVD STE F, FORT WALTON BEACH, FL 32547-1349
(850) 396-1110
Mailing address
208 MARY ESTHER BLVD, MARY ESTHER, FL 32569-1687
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
ME116308
FL
Other
Enumeration date
08/23/2016
Last updated
09/27/2024
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