MEDICARE: DR. STEPHEN SOLLOT D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS7631	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	56716A	OTHER	FL	MEDICARE PTAN
3	P00614918	OTHER	FL	RAILROAD MEDICARE
5	080182478	OTHER	FL	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56716	OTHER	FL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093707267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN SOLLOT D.O.

Provider Business Mailing Address
First Line	:	4315 TAMIAMI TRL S
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-5117
Country	:	US
Telephone Number	:	941-497-4303
Fax Number	:	941-497-3107

Provider Business Practice Location Address
First Line	:	4315 TAMIAMI TRL S
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-5117
Country	:	US
Telephone Number	:	941-497-4303
Fax Number	:	941-497-3107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	01/23/2013

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Directions to “ DR. STEPHEN SOLLOT D.O.” Practice Location

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